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Lo J, Heisler M, Vanzan V, Karst S, Matovinović IZ, Lončarić S, Navajas EV, Beg MF, Šarunić MV. Microvasculature Segmentation and Intercapillary Area Quantification of the Deep Vascular Complex Using Transfer Learning. Transl Vis Sci Technol 2020; 9:38. [PMID: 32855842 PMCID: PMC7424950 DOI: 10.1167/tvst.9.2.38] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 05/08/2020] [Indexed: 12/28/2022] Open
Abstract
Purpose Optical coherence tomography angiography (OCT-A) permits visualization of the changes to the retinal circulation due to diabetic retinopathy (DR), a microvascular complication of diabetes. We demonstrate accurate segmentation of the vascular morphology for the superficial capillary plexus (SCP) and deep vascular complex (DVC) using a convolutional neural network (CNN) for quantitative analysis. Methods The main CNN training dataset consisted of retinal OCT-A with a 6 × 6-mm field of view (FOV), acquired using a Zeiss PlexElite. Multiple-volume acquisition and averaging enhanced the vasculature contrast used for constructing the ground truth for neural network training. We used transfer learning from a CNN trained on smaller FOVs of the SCP acquired using different OCT instruments. Quantitative analysis of perfusion was performed on the resulting automated vasculature segmentations in representative patients with DR. Results The automated segmentations of the OCT-A images maintained the distinct morphologies of the SCP and DVC. The network segmented the SCP with an accuracy and Dice index of 0.8599 and 0.8618, respectively, and 0.7986 and 0.8139, respectively, for the DVC. The inter-rater comparisons for the SCP had an accuracy and Dice index of 0.8300 and 0.6700, respectively, and 0.6874 and 0.7416, respectively, for the DVC. Conclusions Transfer learning reduces the amount of manually annotated images required while producing high-quality automatic segmentations of the SCP and DVC that exceed inter-rater comparisons. The resulting intercapillary area quantification provides a tool for in-depth clinical analysis of retinal perfusion. Translational Relevance Accurate retinal microvasculature segmentation with the CNN results in improved perfusion analysis in diabetic retinopathy.
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Affiliation(s)
- Julian Lo
- School of Engineering Science, Simon Fraser University, Burnaby, BC, Canada
| | - Morgan Heisler
- School of Engineering Science, Simon Fraser University, Burnaby, BC, Canada
| | - Vinicius Vanzan
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Sonja Karst
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, BC, Canada.,Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | | | - Sven Lončarić
- Faculty of Electrical Engineering and Computing, University of Zagreb, Zagreb, Croatia
| | - Eduardo V Navajas
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Mirza Faisal Beg
- School of Engineering Science, Simon Fraser University, Burnaby, BC, Canada
| | - Marinko V Šarunić
- School of Engineering Science, Simon Fraser University, Burnaby, BC, Canada
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Ho M, Lai FHP, Ng DSC, Iu LPL, Chen LJ, Mak ACY, Yip Y, Cheung C, Young AL, Brelen M. Analysis of choriocapillaris perfusion and choroidal layer changes in patients with chronic central serous chorioretinopathy randomised to micropulse laser or photodynamic therapy. Br J Ophthalmol 2020; 105:555-560. [PMID: 32532761 DOI: 10.1136/bjophthalmol-2020-316076] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 01/17/2023]
Abstract
PURPOSE The purpose of this study was to investigate the signal changes in choriocapillaris flow deficits and choroidal thickness changes using swept-source optical coherence tomography angiography (OCTA) following different treatments. DESIGN A double-blind, randomised controlled trial. METHODS Patients with unilateral chronic central serous chorioretinopathy (CSC) were randomised to receive subthreshold micropulse laser therapy (MLT) or half-dose photodynamic therapy (PDT). Choroidal thickness and choriocapillaris flow deficit signals were investigated. RESULTS Eighteen patients were randomised into the MLT group and 15 patients into the PDT group. Areas with flow deficit signals were identified in all baseline OCTA images of the choriocapillaris, with mean areas of 0.420 and 0.465 mm2 in the MLT and PDT groups, respectively. These flow deficit signal areas were significantly reduced at 6 months (p=0.011) in the MLT group and at 3 months (p=0.008) in the PDT group. Patients from the PDT group were shown to have smaller flow deficit areas than patients from the MLT group at all time points after treatment (p=0.001, analyses of variance). The mean choroidal volume of the fovea showed a significant reduction at 1 month (p=0.003), 3 months (p=0.199) and 6 months (p=0.006) in the PDT group. CONCLUSION The flow deficit areas identified in the choriocapillaris layer may suggest possible relative choroidal ischaemia. With measurement of choroidal volume reduction and faster rates of flow deficit area change, PDT has a stronger effect than MLT in promoting choriocapillaris recovery.
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Affiliation(s)
- Mary Ho
- Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
| | | | - Danny Siu Chun Ng
- Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong, China
| | - Lawrence Pui Leung Iu
- Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
| | - Li Jia Chen
- Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
| | - Andrew Chun Yue Mak
- Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
| | - Yolanda Yip
- Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong, China
| | - Carol Cheung
- Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong, China
| | - Alvin Lerrmann Young
- Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
| | - Marten Brelen
- Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong, China .,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
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Chua J, Sim R, Tan B, Wong D, Yao X, Liu X, Ting DSW, Schmidl D, Ang M, Garhöfer G, Schmetterer L. Optical Coherence Tomography Angiography in Diabetes and Diabetic Retinopathy. J Clin Med 2020; 9:E1723. [PMID: 32503234 PMCID: PMC7357089 DOI: 10.3390/jcm9061723] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 05/24/2020] [Accepted: 06/02/2020] [Indexed: 12/21/2022] Open
Abstract
Diabetic retinopathy (DR) is a common complication of diabetes mellitus that disrupts the retinal microvasculature and is a leading cause of vision loss globally. Recently, optical coherence tomography angiography (OCTA) has been developed to image the retinal microvasculature, by generating 3-dimensional images based on the motion contrast of circulating blood cells. OCTA offers numerous benefits over traditional fluorescein angiography in visualizing the retinal vasculature in that it is non-invasive and safer; while its depth-resolved ability makes it possible to visualize the finer capillaries of the retinal capillary plexuses and choriocapillaris. High-quality OCTA images have also enabled the visualization of features associated with DR, including microaneurysms and neovascularization and the quantification of alterations in retinal capillary and choriocapillaris, thereby suggesting a promising role for OCTA as an objective technology for accurate DR classification. Of interest is the potential of OCTA to examine the effect of DR on individual retinal layers, and to detect DR even before it is clinically detectable on fundus examination. We will focus the review on the clinical applicability of OCTA derived quantitative metrics that appear to be clinically relevant to the diagnosis, classification, and management of patients with diabetes or DR. Future studies with longitudinal design of multiethnic multicenter populations, as well as the inclusion of pertinent systemic information that may affect vascular changes, will improve our understanding on the benefit of OCTA biomarkers in the detection and progression of DR.
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Affiliation(s)
- Jacqueline Chua
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore; (J.C.); (R.S.); (B.T.); (D.W.); (X.Y.); (X.L.); (D.S.W.T.); (M.A.)
- Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore 639798, Singapore
| | - Ralene Sim
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore; (J.C.); (R.S.); (B.T.); (D.W.); (X.Y.); (X.L.); (D.S.W.T.); (M.A.)
| | - Bingyao Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore; (J.C.); (R.S.); (B.T.); (D.W.); (X.Y.); (X.L.); (D.S.W.T.); (M.A.)
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore 639798, Singapore
- Institute of Health Technologies, Nanyang Technological University, Singapore 639798, Singapore
| | - Damon Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore; (J.C.); (R.S.); (B.T.); (D.W.); (X.Y.); (X.L.); (D.S.W.T.); (M.A.)
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore 639798, Singapore
- Institute of Health Technologies, Nanyang Technological University, Singapore 639798, Singapore
| | - Xinwen Yao
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore; (J.C.); (R.S.); (B.T.); (D.W.); (X.Y.); (X.L.); (D.S.W.T.); (M.A.)
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore 639798, Singapore
- Institute of Health Technologies, Nanyang Technological University, Singapore 639798, Singapore
| | - Xinyu Liu
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore; (J.C.); (R.S.); (B.T.); (D.W.); (X.Y.); (X.L.); (D.S.W.T.); (M.A.)
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore 639798, Singapore
| | - Daniel S. W. Ting
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore; (J.C.); (R.S.); (B.T.); (D.W.); (X.Y.); (X.L.); (D.S.W.T.); (M.A.)
- Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Doreen Schmidl
- Department of Clinical Pharmacology, Medical University of Vienna, 1090 Vienna, Austria; (D.S.); (G.G.)
| | - Marcus Ang
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore; (J.C.); (R.S.); (B.T.); (D.W.); (X.Y.); (X.L.); (D.S.W.T.); (M.A.)
- Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Gerhard Garhöfer
- Department of Clinical Pharmacology, Medical University of Vienna, 1090 Vienna, Austria; (D.S.); (G.G.)
| | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore; (J.C.); (R.S.); (B.T.); (D.W.); (X.Y.); (X.L.); (D.S.W.T.); (M.A.)
- Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore 639798, Singapore
- Institute of Health Technologies, Nanyang Technological University, Singapore 639798, Singapore
- Department of Clinical Pharmacology, Medical University of Vienna, 1090 Vienna, Austria; (D.S.); (G.G.)
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, 1090 Vienna, Austria
- Institute of Molecular and Clinical Ophthalmology, CH-4031 Basel, Switzerland
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104
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Brar M, Sharma M, Grewal SPS, Grewal DS. Quantification of retinal microvasculature and neurodegeneration changes in branch retinal vein occlusion after resolution of cystoid macular edema on optical coherence tomography angiography. Indian J Ophthalmol 2020; 67:1864-1869. [PMID: 31638051 PMCID: PMC6836591 DOI: 10.4103/ijo.ijo_1554_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose To compare foveal avascular zone (FAZ) area and circularity, ganglion cell layer (GCL) thickness, retinal perfusion density (PD), and vessel density (VD) in eyes with branch retinal vein occlusion (BRVO) after resolution of cystoid macular edema (CME) to fellow control eyes and to correlate these parameters with visual acuity (VA). Methods SD-OCTA scans (Zeiss Angioplex; Carl Zeiss Meditec Version 10) obtained on 32 eyes with BRVO after resolution of the CME with their fellow eyes used as controls were retrospectively evaluated. Parameters analyzed were FAZ size and circularity, PD, and VD in the superficial capillary plexus measured in the Early Treatment Diabetic Retinopathy Study (ETDRS) grid pattern using the automated algorithm. GCL thickness was generated from the Macular Cube 512 × 218 protocol. VA measured on the same day as OCTA examination was recorded. Results The mean FAZ area was greater (P = 0.01) in BRVO eyes (0.239 ± 0.108 mm2) when compared with fellow eyes (0.290 ± 0.127 mm2). The FAZ was more irregular in BRVO eyes compared with fellow eyes (circularity index = 64.6 ± 12.8% vs 71.1 ± 10.8%, respectively, P= 0.03). GCL thickness was lower in BRVO eyes compared with control eyes (67.19 ± 27.71 vs 77.79 ± 6.41 respectively, P= 0.006). The mean VD and PD were significantly lower in the ETDRS outer ring in BRVO eyes (P = 0.04 and 0.038, respectively). On comparison of the affected quadrant with the unaffected quadrant in BRVO eyes, the affected quadrant had a lower outer PD (P = 0.04), outer VD (P = 0.04), and GCL thickness (P = 0.02). There was no significant correlation of VA with FAZ, VD, or GCL thickness (P >0.05). Conclusion FAZ is more irregular and enlarged, and GCL is thinner, in eyes with BRVO after resolution of CME especially in the affected quadrant suggesting neuronal degeneration as a sequela of BRVO. Both perfusion and VD are reduced in the quadrant affected by the BRVO demonstrating regional quantitative differences in the retinal microvasculature. These parameters may prove useful in monitoring the disease progression and treatment response.
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Affiliation(s)
- Manpreet Brar
- Department of Retina, Grewal Eye Institute, Chandigarh, India
| | - Mansi Sharma
- Department of Retina, Grewal Eye Institute, Chandigarh, India
| | - S P S Grewal
- Department of Retina, Grewal Eye Institute, Chandigarh, India
| | - Dilraj S Grewal
- Department of Ophthalmology, Duke University, Durham, North Carolina
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105
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Jung JJ, Yu DJG, Zeng A, Chen MH, Shi Y, Nassisi M, Marion KM, Sadda SR, Hoang QV. Correlation of Quantitative Measurements with Diabetic Disease Severity Using Multiple En Face OCT Angiography Image Averaging. Ophthalmol Retina 2020; 4:1069-1082. [PMID: 32389888 DOI: 10.1016/j.oret.2020.04.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/22/2020] [Accepted: 04/30/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE To evaluate the effect of averaging en face OCT angiography (OCTA) images on quantitative measurements of the retinal microvasculature and their correlation to diabetic retinopathy (DR) disease severity. DESIGN Cross-sectional cohort study. PARTICIPANTS One hundred five eyes (65 patients) comprising 28 eyes from 19 healthy, aged-matched control participants, 14 eyes from 9 diabetics without DR, and 63 eyes from 37 diabetics with varying levels of DR. METHODS Spectral-domain CIRRUS 5000 (Carl Zeiss Meditec, Dublin, CA) OCTA images with no macular edema or significant motion artifact were acquired 5 times with the 3 × 3-mm scan pattern. En face images of the superficial retinal layer (SRL) and deep retinal layer were registered and averaged. Vessel length density (VLD), perfusion density (PD), and foveal avascular zone (FAZ) parameters were measured on averaged versus single OCTA images. MAIN OUTCOME MEASURES Univariate and multivariate linear regression correlated quantitative metrics to DR severity and best-corrected visual acuity (BCVA). RESULTS Eighty-four eyes (55 patients) met the inclusion criteria. Almost uniformly, lower VLD and PD parameters were associated significantly with worse DR severity and BCVA. Multivariate linear regression for DR severity resulted in an R2 value of 0.82 and 0.77 for single and averaged groups, respectively. No variables remained associated significantly with DR severity in multivariate analysis with single images, but in averaged images, increased superior SRL PD significantly predicted worse DR severity (coefficient, 52.7; P = 0.026). Multivariate linear regression for BCVA had an R2 value of 0.42 and 0.47 for single and averaged groups, respectively. Foveal avascular zone size was not associated with DR severity when single OCTA images (P = 0.98) were considered, but was highly associated when using averaged images (coefficient, 6.18; P < 0.001). Foveal avascular zone size was predictive for logarithm of the minimum angle of resolution BCVA with averaged images (0.21; P = 0.004), but not with single images (P = 0.31). CONCLUSIONS Averaging of en face OCTA images improves the visualization of capillaries, particularly increasing the clarity of the FAZ borders, and therefore improves the correlation of vessel density and FAZ-specific parameters to DR severity and BCVA.
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Affiliation(s)
- Jesse J Jung
- East Bay Retina Consultants, Inc, Oakland, California; Department of Ophthalmology, University of California, San Francisco, San Francisco, California.
| | - Daryle Jason G Yu
- Singapore Eye Research Institute, Singapore National Eye Centre, Duke-NUS Medical School, Singapore, Republic of Singapore
| | - Anne Zeng
- East Bay Retina Consultants, Inc, Oakland, California
| | | | - Yue Shi
- Doheny Eye Institute, Los Angeles, California
| | - Marco Nassisi
- Doheny Eye Institute, Los Angeles, California; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | | | - Srinivas R Sadda
- Doheny Eye Institute, Los Angeles, California; Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Quan V Hoang
- Singapore Eye Research Institute, Singapore National Eye Centre, Duke-NUS Medical School, Singapore, Republic of Singapore; Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University College of Physicians and Surgeons, New York, New York
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106
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Zhang J, Qiao Y, Sarabi MS, Khansari MM, Gahm JK, Kashani AH, Shi Y. 3D Shape Modeling and Analysis of Retinal Microvasculature in OCT-Angiography Images. IEEE TRANSACTIONS ON MEDICAL IMAGING 2020; 39:1335-1346. [PMID: 31647423 PMCID: PMC7174137 DOI: 10.1109/tmi.2019.2948867] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
3D optical coherence tomography angiography (OCT-A) is a novel and non-invasive imaging modality for analyzing retinal diseases. The studies of microvasculature in 2D en face projection images have been widely implemented, but comprehensive 3D analysis of OCT-A images with rich depth-resolved microvascular information is rarely considered. In this paper, we propose a robust, effective, and automatic 3D shape modeling framework to provide a high-quality 3D vessel representation and to preserve valuable 3D geometric and topological information for vessel analysis. Effective vessel enhancement and extraction steps by means of curvelet denoising and optimally oriented flux (OOF) filtering are first designed to produce 3D microvascular networks. Afterwards, a novel 3D data representation of OCT-A microvasculature is reconstructed via advanced mesh reconstruction techniques. Based on the 3D surfaces, shape analysis is established to extract novel shape-based microvascular area distortion via the Laplace-Beltrami eigen-projection. The extracted feature is integrated into a graph-cut segmentation system to categorize large vessels and small capillaries for more precise shape analysis. The proposed framework is validated on a dedicated repeated scan dataset including 260 volume images and shows high repeatability. Statistical analysis using the surface area biomarker is performed on small capillaries to avoid the effect of tailing artifact from large vessels. It shows significant differences ( ) between DR stages on 100 subjects in a OCTA-DR dataset. The proposed shape modeling and analysis framework opens the possibility for further investigating OCT-A microvasculature in a new perspective.
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Affiliation(s)
- Jiong Zhang
- Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA; USC Roski Eye Institute, Keck School of Medicine of University of Southern California, Los Angeles, CA 90033, USA
| | - Yuchuan Qiao
- Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Mona Sharifi Sarabi
- Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Maziyar M. Khansari
- Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA; USC Roski Eye Institute, Keck School of Medicine of University of Southern California, Los Angeles, CA 90033, USA
| | - Jin K. Gahm
- Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Amir H. Kashani
- USC Roski Eye Institute, Keck School of Medicine of University of Southern California, Los Angeles, CA 90033, USA
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Eser-Ozturk H, Ismayilova L, Yucel OE, Sullu Y. Quantitative measurements with optical coherence tomography angiography in Behçet uveitis. Eur J Ophthalmol 2020; 31:1047-1055. [PMID: 32345049 DOI: 10.1177/1120672120920214] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The aim of this study was to evaluate the quantitative measurements obtained by optical coherence tomography angiography in patients with Behçet uveitis. METHODS A total of 22 consecutive patients with Behçet uveitis and 19 age-matched healthy individuals were included in the study. Quantitative analysis of optical coherence tomography angiography images was performed. Comparisons between the patients and the control groups and correlation analysis between optical coherence tomography angiography results and age, visual acuity, duration of uveitis, central macular thickness, and fluorescein angiography scores in the patient group was performed. RESULTS The mean superficial foveal avascular zone area was 283.040 ± 113.003 µm2 in the patient group and 254.268 ± 75.813 µm2 in the control group (p = 0.821). The mean deep foveal avascular zone area was 317.657 ± 116.225 µm2 in the patient group and 332.954 ± 94.783 µm2 in the control group (p = 0.775). The foveal avascular zone area could not be calculated in eight eyes with macular atrophy in the patient group because of unclear foveal avascular zone borders. Both superficial and deep capillary vessel density in all regions were lower in the patient group than in the control. Superior, inferior, and temporal capillary vessel density were correlated with fluorescein angiography score (Pearson's r = -0.380, 0.392, and -0.384, p < 0.05 in superficial plexus; r = -0.357, -0.401, and -0.321, p < 0.05 in deep plexus, respectively). The foveal avascular zone area was correlated with central macular thickness in both superficial and deep plexus (r = -0.387 and -0.331, p < 0.05, respectively). CONCLUSION Recurrent uveitis attacks affecting the macula are associated with a decrease in capillary vessel density and expansion in the foveal avascular zone area in Behçet disease. The qualitative evaluation of the optical coherence tomography angiography findings may be more valuable in patients with macular atrophy.
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Affiliation(s)
- Hilal Eser-Ozturk
- Department of Ophthalmology, 37139Ondokuz Mayis University, Samsun, Turkey
| | - Leman Ismayilova
- Department of Ophthalmology, 37139Ondokuz Mayis University, Samsun, Turkey
| | - Ozlem Eski Yucel
- Department of Ophthalmology, 37139Ondokuz Mayis University, Samsun, Turkey
| | - Yuksel Sullu
- Department of Ophthalmology, 37139Ondokuz Mayis University, Samsun, Turkey
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Abdelshafy M, Abdelshafy A. Correlations Between Optical Coherence Tomography Angiography Parameters and the Visual Acuity in Patients with Diabetic Retinopathy. Clin Ophthalmol 2020; 14:1107-1115. [PMID: 32425497 PMCID: PMC7186882 DOI: 10.2147/opth.s248881] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 04/02/2020] [Indexed: 11/29/2022] Open
Abstract
Aim The aim of this study was to assess the correlation between different optical coherence tomography angiography (OCTA) parameters and the best corrected visual acuity (BCVA) in patients with diabetic retinopathy (DR). Patients and Methods Sixty eyes of 60 participants were included in this prospective study: 40 diabetic patients [20 with non-proliferative diabetic retinopathy (NPDR group), 20 with proliferative diabetic retinopathy (PDR group)] and 20 age- and gender-matched normal healthy subjects (control group). After full ophthalmological examination and fundus fluorescein angiography, OCTA was performed for all participants. Quantitative OCTA parameters, such as the foveal avascular zone (FAZ) area, the superficial capillary plexus vessel density (%) (SCP-VD) and the deep capillary plexus vessel density (%) (DCP-VD) in, whole and parafoveal areas were measured. Correlations between BCVA and OCTA parameters were analyzed. Results There were no statistically significant differences between groups regarding age, gender, refraction, macular thickness or intraocular pressure. The median (IQR) FAZ area was 0.42 (0.39–0.46) mm2 in the NPDR group, 0.54 (0.45–0.65) mm2 in the PDR group and 0.24 (0.21–0.26) mm2 in the control group (P<0.001). The FAZ area increased with increasing severity of DR. SCP-VD and DCP-VD showed significant differences between groups (P<0.001). Vessel density (VD) was decreased in both DCP and SCP as DR progressed. There was a significant positive correlation between BCVA (LogMAR) and FAZ area. There were significant negative correlations between BCVA (LogMAR) and VD in both SCP and DCP. Stepwise multiple linear regression analysis demonstrated that SCP-VD in the whole area and DCP-VD in the parafoveal area were the best predictive factors for BCVA in the NPDR and PDR groups. Conclusion With progression of DR, the VD decreased and the FAZ area increased, and both parameters were correlated with poor visual acuity. OCTA is a non-invasive tool which can be used to detect diabetic macular ischemia and help in the prediction of visual prognosis.
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Affiliation(s)
- Marwa Abdelshafy
- Ophthalmology Department, Benha Faculty of Medicine, Benha University, Benha, Egypt
| | - Ahmed Abdelshafy
- Ophthalmology Department, Benha Faculty of Medicine, Benha University, Benha, Egypt
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Babiuch AS, Uchida A, Hu M, Khan M, Srivastava SK, Singh RP, Kaiser PK, Rachtiskaya A, Reese JL, Ehlers JP. Use of OCTA Capillary Perfusion Density Measurements to Detect and Grade Macular Ischemia. Ophthalmic Surg Lasers Imaging Retina 2020; 51:S30-S36. [PMID: 32348532 DOI: 10.3928/23258160-20200401-04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 10/25/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To compare optical coherence tomography angiography (OCTA) capillary perfusion density (CPD) measurements of normal eyes and eyes with macular ischemia (MI). PATIENTS AND METHODS AVATAR is an institutional review board-approved, prospective, observational imaging study using the Avanti RTVue XR HD. OCTA reports were reviewed for the presence of MI. Qualitative MI grading was performed, and CPD metrics in the superficial and deep fovea and parafovea were analyzed. A normal eye cohort was identified for comparative assessment. RESULTS The MI and normal cohorts included 55 and 58 eyes, respectively. Compared to normal eyes, eyes with MI had significantly lower CPD values in all regions. There was a statistically significant correlation between qualitative MI grade and VA in the superficial (P = .003) and deep plexuses (P = .029). Only deep parafoveal CPD values demonstrated correlation with VA (P = .043). CONCLUSIONS Eyes with MI determined by masked qualitative OCTA grading demonstrated significantly reduced CPD values compared to normal eyes. Categorical assessment of MI severity correlated with VA. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:S30-S36.].
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Terheyden JH, Wintergerst MWM, Falahat P, Berger M, Holz FG, Finger RP. Automated thresholding algorithms outperform manual thresholding in macular optical coherence tomography angiography image analysis. PLoS One 2020; 15:e0230260. [PMID: 32196538 PMCID: PMC7083322 DOI: 10.1371/journal.pone.0230260] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 02/25/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction For quantification of Optical Coherence Tomography Angiography (OCTA) images, Vessel Density (VD) and Vessel Skeleton Density (VSD) are well established parameters and different algorithms are in use for their calculation. However, comparability, reliability and ability to discriminate healthy and impaired macular perfusion of different algorithms are unclear, yet, of potential high clinical relevance. Hence, we assessed comparability and test-retest reliability of the most common approaches. Materials and methods Two consecutive 3×3mm OCTA en face images of the superficial and deep retinal layer were acquired with swept-source OCTA. VD and VSD were calculated with manual thresholding and six automated thresholding algorithms (Huang, Li, Otsu, Moments, Mean, Percentile) using ImageJ and compared in terms of intra-class correlation coefficients, measurement differences and repeatability coefficients. Receiver operating characteristic analyses (healthy vs. macular pathology) were performed and Area Under the Curve (AUC) values were calculated. Results Twenty-six eyes (8 female, mean age: 47 years) of 15 patients were included (thereof 15 eyes with macular pathology). Binarization thresholds, VD and VSD differed significantly between the algorithms and compared to manual thresholding (p < 0.0001). Inter-measurement differences did not differ significantly between patients with healthy versus pathologic maculae (p ≥ 0.685). Reproducibility was higher for the automated algorithms compared to manual thresholding on all measures of reproducibility assessed. AUC was significantly higher for the Mean algorithm compared to the manual approach with respect to the superficial retinal layer. Conclusions Automated thresholding algorithms yield a higher reproducibility of OCTA parameters and allow for a more sensitive diagnosis of macular pathology. However, different algorithms are not interchangeable nor results readily comparable. Especially the Mean algorithm should be investigated in further detail. Automated thresholding algorithms are preferable but more standardization is needed for clinical use.
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Affiliation(s)
| | | | - Peyman Falahat
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Moritz Berger
- Department of Medical Biometry, Informatics and Epidemiology, University of Bonn, Bonn, Germany
| | - Frank G. Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Robert P. Finger
- Department of Ophthalmology, University of Bonn, Bonn, Germany
- * E-mail:
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Assessment of superficial and deep retinal vessel density in systemic lupus erythematosus patients using optical coherence tomography angiography. Graefes Arch Clin Exp Ophthalmol 2020; 258:1261-1268. [PMID: 32162113 DOI: 10.1007/s00417-020-04626-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 01/13/2020] [Accepted: 02/11/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE The aim of this study is to evaluate the retinal microvascular density in SLE patients using optical coherence tomography angiography (OCTA) and to correlate vascular density with the disease activity and damage risk. METHODS Twenty eyes of 20 SLE patients were compared with 20 eyes of normal subjects. The retinal capillary plexuses were examined by OCTA. The disease activity and damage risk were evaluated by the SLEDAI-2 K and SLICC/ACR SDI scoring systems. RESULTS No difference was found between SLE patients' central foveal thickness (CFT) and foveal avascular zone (FAZ) area and the normal (P > 0.05). SLE patients had slightly lower superficial vessel densities than normal in the upper and lower macular regions (P < 0.05), sparing the middle sectors (P > 0.05). In the deep plexus, vessel density loss was detected in all sectors (P < 0.001). The vessel density in 300-μm-wide region around the FAZ (FD-300) and the acircularity index (AI) were affected in the SLE in comparison to the normal group (P < 0.05). No significant correlation was found between the SLEDAI-2 k and the retinal vessel density in either layer, while the SLICC/SDI had moderate inverse correlation with vessel density in some sectors (P < 0.05). Receiver operating characteristic (ROC) curve analysis showed that the deep capillary plexus had high sensitivity and specificity for detecting vascular damage in SLE patients. CONCLUSIONS OCTA permits noninvasive quantitative assessment of retinal vessel density in SLE, allowing early detection of altered retinal circulation. Vessel density could be included in future assessment of SLE activity and damage scores.
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Korkmaz MF, Can ME, Kazancı EG. Effects of iron deficiency anemia on peripapillary and macular vessel density determined using optical coherence tomography angiography on children. Graefes Arch Clin Exp Ophthalmol 2020; 258:2059-2068. [PMID: 32125506 DOI: 10.1007/s00417-020-04633-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 02/12/2020] [Accepted: 02/17/2020] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To evaluate retinal vascular parameters by optical coherence tomography angiography (OCT-A) in iron deficiency anemia (IDA). METHODS Thirty-two patients with IDA (study group) and 30 healthy children (control group) were enrolled in the study. All subjects underwent a complete ocular examination. OCT-A scans were performed in a 6 × 6 mm area centered on the macula. Foveal avascular zone (FAZ), non-flow area (NFA), FAZ perimeter (PERIM), acircularity index (AI) of FAZ, and foveal density (FD) were measured in the superficial capillary plexus (SCP) and deep capillary plexus (DCP). SCP and DCP were also scanned centered on the optic disk. Hemoglobin (Hb), mean corpuscular volume (MCV), serum iron, total iron-binding capacity (TIBC), and ferritin were also studied and compared for both groups. RESULTS The mean age was 12.22 ± 4.48 years (ranged 5-18 years) in the study group and 12.37 ± 3.76 years (ranged 6-18 years) in the control group. The mean FAZ value was 0.290 ± 0.09 mm2 in the study group and 0.298 ± 0.11 mm2 in the control group. The mean NFA value was 0.477 ± 0.10 mm2 in the study group and 0.486 ± 0.13 mm2 in the control group (p > 0.05). FD and AI were not statistically significant between the study group and control group (p > 0.05). The mean value for SCP was statistically significant between the study group and control group (p < 0.05). The mean value for DCP was not significantly different between the study and control groups (p > 0.05). The mean values for capillary density on optic disk were also statistically significant between the study group and control group (p < 0.05). A negative correlation was found between serum iron, TIBC, and capillary plexus density (p < 0.05). A positive correlation was found between MCV and ferritin values and capillary plexus density (p < 0.05). CONCLUSION IDA had significantly lower capillary plexus density. We detected retinal microvascular changes in young IDA patients before significant ocular anomalies, especially ischemic changes, developed.
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Affiliation(s)
- Muhammet Furkan Korkmaz
- Department of Pediatrics, Yuksek Ihtisas Training and Research Hospital, University of Health Sciences, Bursa, Turkey.
| | - Mehmet Erol Can
- Department of Ophthalmology, Bursa City Hospital, Bursa, Turkey
| | - Elif Güler Kazancı
- Department of Pediatric Hematology, Yuksek Ihtisas Training and Research Hospital, University of Health Sciences, Bursa, Turkey
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QUANTIFICATION OF RETINAL CAPILLARY NONPERFUSION IN DIABETICS USING WIDE-FIELD OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY. Retina 2020; 40:412-420. [DOI: 10.1097/iae.0000000000002403] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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114
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Hormel TT, Huang D, Jia Y. Artifacts and artifact removal in optical coherence tomographic angiography. Quant Imaging Med Surg 2020; 11:1120-1133. [PMID: 33654681 DOI: 10.21037/qims-20-730] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Optical coherence tomographic angiography (OCTA) enables rapid imaging of retinal vasculature in three dimensions. While the technique has provided quantification of healthy vessels as well as pathology in several diseases, it is not unusual for OCTA data to contain artifacts that may influence measurement outcomes or defy image interpretation. In this review, we discuss the sources of several OCTA artifacts-including projection, motion, and signal reduction-as well as strategies for their removal. Artifact compensation can improve the accuracy of OCTA measurements, and the most effective use of the technology will incorporate hardware and software that can perform such correction.
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Affiliation(s)
- Tristan T Hormel
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
| | - David Huang
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
| | - Yali Jia
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA.,Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA
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Wang W, He M, Gong X, Wang L, Meng J, Li Y, Xiong K, Li W, Huang W. Association of renal function with retinal vessel density in patients with type 2 diabetes by using swept-source optical coherence tomographic angiography. Br J Ophthalmol 2020; 104:1768-1773. [PMID: 32098859 DOI: 10.1136/bjophthalmol-2019-315450] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/31/2020] [Accepted: 02/10/2020] [Indexed: 12/16/2022]
Abstract
AIMS To investigate the relationship between retinal vessel density and renal function in patients with diabetes mellitus (DM) using non-invasive optical coherence tomographic angiography (OCTA). METHODS This prospective cross-sectional study recruited ocular-treatment-naïve patients with DM registered in the community of Guangzhou, China. The retinal vessel density of the superficial capillary plexus in the macula was obtained by using swept-source OCTA imaging. The Xiangya equation was used to calculate the estimated glomerular filtrate rate (eGFR). Participants were divided into the following groups by eGFR: no chronic kidney disease (non-CKD), mild CKD and moderate-to-severe CKD (MS-CKD). RESULTS A total of 874 patients with DM (874 eyes), with a mean age of 64.8±7.1 years, were included in the final analysis. The vessel density was significantly lower in patients with CKD than in non-CKD patients in a dose-response pattern, with a parafoveal vessel density of 49.1%±2.1% in non-CKD, 48.4%±1.9% in mild CKD and 47.2%±1.7% in MS-CKD (p<0.001). The sparser retinal capillaries were related to lower eGFR (β=0.037; 95% CI 0.025 to 0.049; p<0.001) and higher microalbuminuria (β = -0.023; 95% CI -0.039 to -0.008; p=0.002). The eGRF was independently associated with parafoveal vessel density (β=0.029; 95% CI 0.016 to 0.042; p<0.001), even after adjusting for other factors. CONCLUSION Retinal vessel density decreased with renal function impairment, underlining the potential value of OCTA to detect early microvascular damage in the kidney in patients with diabetes.
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Affiliation(s)
- Wei Wang
- Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Miao He
- Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Xia Gong
- Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Lanhua Wang
- Department of Preventive Ophthalmology, Zhongshan Ophthalmic Center, Guangzhou, Guangdong, China
| | - Jie Meng
- Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yuting Li
- Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Kun Xiong
- Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Wangting Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Wenyong Huang
- Department of Preventive Ophthalmology, Zhongshan Ophthalmic Center, Guangzhou, Guangdong, China
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Sampson DM, Ali N, Au Yong A, Jeewa R, Rajgopal S, Dutt DDCS, Mohamed S, Mohamed S, Hansen A, Menghini M, Chen FK. RTVue XR AngioVue Optical Coherence Tomography Angiography Software Upgrade Impacts on Retinal Thickness and Vessel Density Measurements. Transl Vis Sci Technol 2020; 9:10. [PMID: 32714636 PMCID: PMC7351533 DOI: 10.1167/tvst.9.3.10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Purpose To determine the impact of an AngioVue software upgrade on total retinal thickness (RT) and inner retinal vessel density (VD) measurements derived from optical coherence tomography angiography (OCTA). Methods Optovue OCTA images (3 × 3 mm) from 126 individuals (105 healthy eyes and 72 eyes with retinal disease) were acquired before an upgrade of the AngioVue software, which resulted in an inward shift of the outer boundary of the inner retinal vessels and improved Bruch's membrane segmentation. Total RT and inner retinal VD values were extracted before and after the software upgrade for comparison. Bias and limits of agreement (LA) were calculated. Results The mean (SD) age of participants was 46 (17) years. Mean (LA) foveal RT increased by 3.0 (–11 to +17) and 3.7 (–11 to +18) µm (P < 0.001) and parafoveal RT increased by 9.7 (–3.8 to +23) and 6.4 (–2.5 to +15) µm (P < 0.001) in healthy and diseased retina, respectively. Mean (LA) foveal inner retinal VD decreased by 6.6 (2.5–11) and 7.7 (0.4–15) percentage units (P < 0.001) and parafoveal inner retinal VD decreased by 4.1 (1.2–7.0) and 4.7 (0.5–8.9) percentage units (P < 0.001) in healthy and diseased retina, respectively. Conclusions The AngioVue software upgrade resulted in an unexpected increase in total RT and an expected reduction in inner retinal VD measurements in all regions due to altered segmentation. Translational Relevance RT and VD measures derived from the newer AngioVue software version are not directly comparable to the reported normative data derived from the older software.
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Affiliation(s)
- Danuta M Sampson
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Nedlands, Western Australia, Australia.,Surrey Biophotonics, Centre for Vision, Speech and Signal Processing and School of Biosciences and Medicine, The University of Surrey, Guildford, UK
| | - Noha Ali
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Nedlands, Western Australia, Australia.,Department of Ophthalmology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Alex Au Yong
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Nedlands, Western Australia, Australia
| | - Rumaanah Jeewa
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Nedlands, Western Australia, Australia
| | - Saumya Rajgopal
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Nedlands, Western Australia, Australia
| | - Deepaysh D C S Dutt
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Nedlands, Western Australia, Australia
| | - Sharaf Mohamed
- Department of Ophthalmology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Shehata Mohamed
- Department of Ophthalmology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Alex Hansen
- Department of Ophthalmology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Moreno Menghini
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Nedlands, Western Australia, Australia.,Department of Ophthalmology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Fred K Chen
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Nedlands, Western Australia, Australia.,Department of Ophthalmology, Royal Perth Hospital, Perth, Western Australia, Australia.,Department of Ophthalmology, Perth Children's Hospital, Perth, Western Australia, Australia
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Tang FY, Chan EO, Sun Z, Wong R, Lok J, Szeto S, Chan JC, Lam A, Tham CC, Ng DS, Cheung CY. Clinically relevant factors associated with quantitative optical coherence tomography angiography metrics in deep capillary plexus in patients with diabetes. EYE AND VISION 2020; 7:7. [PMID: 32025523 PMCID: PMC6996172 DOI: 10.1186/s40662-019-0173-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 12/30/2019] [Indexed: 01/04/2023]
Abstract
Background To test clinically relevant factors associated with quantitative artifact-free deep capillary plexus (DCP) metrics in patients with diabetes mellitus (DM). Methods 563 eligible eyes (221 with no diabetic retinopathy [DR], 135 with mild DR, 130 with moderate DR, and 77 with severe DR) from 334 subjects underwent optical coherence tomography-angiography (OCT-A) with a swept-source OCT (Triton DRI-OCT, Topcon, Inc., Tokyo, Japan). Strict criteria were applied to exclude from analysis those DCP images with artifacts and of poor quality, including projection artifacts, motion artifacts, blurriness, signal loss, B-scan segmentation error, or low-quality score. A customized MATLAB program was then used to quantify DCP morphology from the artifact-free DCP images by calculating three metrics: foveal avascular zone (FAZ), vessel density (VD), and fractal dimension (FD). Results 166 (29.5%) eyes were excluded after quality control, leaving in the analysis 397 eyes (170 with no DR, 101 with mild DR, 90 with moderate DR, 36 with severe DR) from 250 subjects. In the multiple regression models, larger FAZ area was associated with more severe DR (β = 0.687; p = 0.037), shorter axial length (AL) (β = − 0.171; p = 0.003), thinner subfoveal choroid thickness (β = − 0.122; p = 0.031), and lower body mass index (BMI) (β = − 0.090; p = 0.047). Lower VD was associated with more severe DR (β = − 0.842; p = 0.001), shorter AL (β = 0.107; p = 0.039), and poorer visual acuity (VA) (β = − 0.133; p = 0.021). Lower FD was associated with more severe DR (β = − 0.891; p < 0.001) and with older age (β = − 0.142; p = 0.004). Conclusions Quantitative artifact-free DCP metrics are associated with VA, DR severity, AL, subfoveal choroidal thickness, age, and BMI in diabetic patients. The effects of ocular and systemic factors should be considered for meaningful interpretations of DCP changes in DM patients.
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Affiliation(s)
- Fang Yao Tang
- 1Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Kowloon, China
| | - Erica O Chan
- 1Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Kowloon, China
| | - Zihan Sun
- 1Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Kowloon, China
| | - Raymond Wong
- 1Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Kowloon, China.,2Hong Kong Eye Hospital, Hong Kong Special Administrative Region, Kowloon, China
| | - Jerry Lok
- 1Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Kowloon, China.,2Hong Kong Eye Hospital, Hong Kong Special Administrative Region, Kowloon, China
| | - Simon Szeto
- 1Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Kowloon, China.,2Hong Kong Eye Hospital, Hong Kong Special Administrative Region, Kowloon, China
| | - Jason C Chan
- 1Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Kowloon, China.,2Hong Kong Eye Hospital, Hong Kong Special Administrative Region, Kowloon, China
| | - Alexander Lam
- 1Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Kowloon, China
| | - Clement C Tham
- 1Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Kowloon, China
| | - Danny S Ng
- 1Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Kowloon, China
| | - Carol Y Cheung
- 1Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Kowloon, China.,3CUHK Eye Centre, Hong Kong Eye Hospital, 147K Argyle Street, Kln, Kowloon, Hong Kong China
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Yao X, Alam MN, Le D, Toslak D. Quantitative optical coherence tomography angiography: A review. Exp Biol Med (Maywood) 2020; 245:301-312. [PMID: 31958986 PMCID: PMC7370602 DOI: 10.1177/1535370219899893] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
As a new optical coherence tomography (OCT) modality, OCT angiography (OCTA) provides a noninvasive method to detect microvascular distortions correlated with eye conditions. By providing unparalleled capability to differentiate individual plexus layers in the retina, OCTA has demonstrated its excellence in clinical management of diabetic retinopathy, glaucoma, sickle cell retinopathy, diabetic macular edema, and other eye diseases. Quantitative OCTA analysis of retinal and choroidal vasculatures is essential to standardize objective interpretations of clinical outcome. Quantitative features, including blood vessel tortuosity, blood vessel caliber, blood vessel density, vessel perimeter index, fovea avascular zone area, fovea avascular zone contour irregularity, vessel branching coefficient, vessel branching angle, branching width ratio, and choroidal vascular analysis have been established for objective OCTA assessment. Moreover, differential artery–vein analysis has been recently demonstrated to improve OCTA performance for objective detection and classification of eye diseases. In this review, technical rationales and clinical applications of these quantitative OCTA features are summarized, and future prospects for using these quantitative OCTA features for artificial intelligence classification of eye conditions are discussed.
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Affiliation(s)
- Xincheng Yao
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60607, USA
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Minhaj N Alam
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60607, USA
| | - David Le
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60607, USA
| | - Devrim Toslak
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60607, USA
- Department of Ophthalmology, Antalya Training and Research Hospital, Antalya 07030, Turkey
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119
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Forte R, Haulani H, Jürgens I. QUANTITATIVE AND QUALITATIVE ANALYSIS OF THE THREE CAPILLARY PLEXUSES AND CHORIOCAPILLARIS IN PATIENTS WITH TYPE 1 AND TYPE 2 DIABETES MELLITUS WITHOUT CLINICAL SIGNS OF DIABETIC RETINOPATHY: A Prospective Pilot Study. Retina 2020; 40:333-344. [PMID: 31972804 DOI: 10.1097/iae.0000000000002376] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To separately evaluate the three retinal capillary plexuses and the choriocapillaris in patients with diabetes mellitus (DM) Type 1 and Type 2, without clinical signs of diabetic retinopathy. METHODS The study was prospective and cross-sectional. Only patients with age ≤55 years were included. We used a swept-source optical coherence tomography angiography device (Triton; Topcon, Tokyo, Japan) to obtain both quantitative and qualitative analysis of the retinal capillary plexuses (superficial capillary plexus; middle capillary plexus; and deep capillary plexus) and the choriocapillaris. RESULTS We included 17 patients with DM Type 1 (age 34.52 ± 11.05 years, 29 eyes), 17 patients with DM Type 2 (age 48.76 ± 3.26 years, 32 eyes), and 23 healthy control subjects (age 41.82 ± 8.97 years, 43 eyes). When compared with controls, vessel density in the central 1 mm was reduced in both DM Type 1 and DM Type 2 groups in the superficial capillary plexus (P = 0.05 and P = 0.02, respectively), and in DM Type 2 in the deep capillary plexus (P = 0.03). Foveal avascular zone was increased in the middle capillary plexus and deep capillary plexus of DM Type 2 group compared with controls (P = 0.03 and P = 0.02, respectively). Choriocapillary voids were more frequent in DM Type 1 and DM Type 2 compared with controls (P = 0.003 and P < 0.001, respectively). CONCLUSION Microvascular modifications are present in the three retinal capillary plexuses and the choriocapillaris in both DM Type 1 and DM Type 2 even in the absence of clinical signs of diabetic retinopathy.
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Affiliation(s)
- Raimondo Forte
- Retina and Vitreous Department, Institut Català de Retina (ICR), Barcelona, Spain
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120
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You QS, Chan JCH, Ng ALK, Choy BKN, Shih KC, Cheung JJC, Wong JKW, Shum JWH, Ni MY, Lai JSM, Leung GM, Cheung CMG, Wong TY, Wong IYH. Macular Vessel Density Measured With Optical Coherence Tomography Angiography and Its Associations in a Large Population-Based Study. Invest Ophthalmol Vis Sci 2020; 60:4830-4837. [PMID: 31747685 DOI: 10.1167/iovs.19-28137] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose We investigate macular perfusion and the systemic and ocular associations in a population-based setting. Methods In this cross-sectional study, 2018 adults residing in Hong Kong underwent detailed ophthalmic examinations after consenting to participate. Macular perfusion was measured with optical coherence tomography angiography (OCTA) using the split-spectrum amplitude decorrelation angiography algorithm. The parafoveal flow index and vessel area density were quantified using automated custom-built software. Results Of the 2018 participants, the OCTA measurements were available for 1940, and 1631 (84.1%) had good quality scans. The right eyes of these 1631 participants (43.1% men) were included for final analysis. Mean age was 49.8 years (range, 18-92 years). Mean global macular vessel density was 47.3% and 55.1% for the superficial and deep retinal layers, respectively. In multivariate analysis, lower superficial vessel density remained significantly associated with lower signal strength index (SSI; P < 0.001, standardized β = 0.607) and male sex (P < 0.001, β = 0.162), and borderline associated with older age (P = 0.09, β = -0.045) and longer axial length (AL; P = 0.09, β = -0.037), while lower deep layer vessel density was significantly associated with lower SSI (P < 0.001, standardized β = 0.667), longer AL (P < 0.001, β = -0.097), and higher creatinine (P < 0.001, β = -0.072). Conclusions This large population-based study provided normative OCTA data of macular vessel density and demonstrated that a lower superficial retinal vessel density was significantly associated with lower SSI and male sex, while a lower deep layer retinal vessel density was significantly associated with lower SSI, longer AL, and higher level of creatinine. These associations must be considered when interpreting clinical quantitative OCTA data.
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Affiliation(s)
- Qi Sheng You
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong.,Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing.,Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, United States
| | - Jonathan C H Chan
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Alex L K Ng
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Bonnie K N Choy
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Kendrick C Shih
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Janice J C Cheung
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Jasper K W Wong
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Jennifer W H Shum
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Michael Y Ni
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Jimmy S M Lai
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Gabriel M Leung
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | | | | | - Ian Y H Wong
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong.,Department of Ophthalmology, Hong Kong Sanatorium & Hospital, Hong Kong
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Stellungnahme der DOG, der RG und des BVA zur Therapie des diabetischen Makulaödems. Ophthalmologe 2020; 117:218-247. [DOI: 10.1007/s00347-019-01015-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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RETINAL LEAKAGE INDEX DYNAMICS ON ULTRA-WIDEFIELD FLUORESCEIN ANGIOGRAPHY IN EYES TREATED WITH INTRAVITREAL AFLIBERCEPT FOR PROLIFERATIVE DIABETIC RETINOPATHY IN THE RECOVERY STUDY. Retina 2020; 40:2175-2183. [PMID: 31917731 DOI: 10.1097/iae.0000000000002727] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Characterization of leakage indices on ultra-widefield fluorescein angiography in proliferative diabetic retinopathy treated with intravitreal aflibercept. METHODS Prospective study enrolling subjects for treatment of proliferative diabetic retinopathy randomized 1:1 to receive 2-mg intravitreal aflibercept every 4 weeks (2q4) or every 12 weeks (2q12). Ultra-widefield fluorescein angiography images obtained at baseline, 24, and 48 weeks were analyzed using a semiautomated leakage segmentation platform. Panretinal and zonal leakage indices were calculated. RESULTS Forty eyes of 40 subjects were included, and mean age was 48 ± 12.1 years. Mean number of injections was 11 ± 1.7 in the 2q4 arm and 4 ± 0.4 in the 2q12 arm. Median baseline leakage index in the 2q4 and 2q12 groups was 5.1% and 4.3%, respectively (P = 0.28). At 24 and 48 weeks, the 2q4 group significantly improved to 1.1% (-79%, P < 0.0001). At Week 24, the 2q12 group demonstrated nonsignificant improvement (3.4%; -21%, P = 0.47); by Week 48, improvement was significant (1.4%; -68%, P = 0.02). The 2q4 group resulted in lower leakage index compared with the 2q12 group at 24 weeks (1.1% vs. 3.4%, respectively; P = 0.008), but by 48 weeks, leakage index was similar between both groups (1.1% vs. 1.4%, respectively; P = 0.34). CONCLUSION Proliferative diabetic retinopathy treated with intravitreal aflibercept demonstrated significant leakage index reductions at 1 year. Monthly dosing provided more rapid reduction in leakage index compared with quarterly dosing. TRIAL REGISTRATION RECOVERY study (NCT02863354); https://clinicaltrials.gov/ct2/show/NCT02863354.
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Novel biomarker of sphericity and cylindricity indices in volume-rendering optical coherence tomography angiography in normal and diabetic eyes: a preliminary study. Graefes Arch Clin Exp Ophthalmol 2020; 258:711-723. [PMID: 31907642 DOI: 10.1007/s00417-019-04582-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 12/05/2019] [Accepted: 12/19/2019] [Indexed: 12/16/2022] Open
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Güler Kazancı E, Korkmaz MF, Can ME. Optical coherence tomography angiography findings in young β-thalassemia patients. Eur J Ophthalmol 2020; 30:600-607. [PMID: 31902243 DOI: 10.1177/1120672119899375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE The purpose was to evaluate retinal vascular parameters by optical coherence tomography angiography in β-thalassemia major patients. METHODS Thirty-three patients with β-thalassemia major (study group) and 29 healthy children (control group) were enrolled in the study. All subjects underwent a complete ocular examination. The mean foveal avascular zone, non-flow area, foveal avascular zone perimeter, acircularity index of foveal avascular zone, foveal density, the superficial capillary plexus, and deep capillary plexus were scanned using 6 × 6 mm optical coherence tomography angiography scans centered on the macula. Superficial capillary plexus and deep capillary plexus were also scanned centered on the optic disk. We collected data on histories of patients, and hemoglobin and ferritin were also studied from both groups. RESULTS The mean age was 13.85 ± 4.69 years (range: 4-21 years) in β-thalassemia major group and 12.59 ± 3.66 years (range: 6-18 years) in the control group. The mean foveal avascular zone value was 0.265 ± 0.11 mm2 in the study group and 0.296 ± 0.12 mm2 in the control group. The mean non-flow area value was 0.468 ± 0.12 mm2 in the study group and 0.479 ± 0.14 mm2 in the control group (p > 0.05). Differences in the mean values for foveal density and acircularity index were statistically significant between the study group and control group (p < 0.05, p = 0.026, and p = 0.026, respectively). Superficial capillary plexus and deep capillary plexus were not a significant difference between the study and control groups in 6 × 6 mm scans on macula and 4.5 × 4.5 mm scans on optic disk area (p > 0.05). Acircularity index was negatively correlated (r = -0.292, p = 0.026), and foveal density was positively correlated with hemoglobin (r = 0.292, p = 0.026). CONCLUSION By using optical coherence tomography angiography, we detected foveal microvascular changes in young β-thalassemia patients before significant ocular anomalies development.
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Affiliation(s)
- Elif Güler Kazancı
- Department of Pediatric Hematology, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Muhammet Furkan Korkmaz
- Department of Pediatrics, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Mehmet Erol Can
- Department of Ophthalmology, Bursa City Hospital, Bursa, Turkey
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Foveal vasculature changes and nonperfusion in patients with diabetes types I and II with no evidence of diabetic retinopathy. Graefes Arch Clin Exp Ophthalmol 2020; 258:551-556. [PMID: 31900642 DOI: 10.1007/s00417-019-04588-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/30/2019] [Accepted: 12/19/2019] [Indexed: 12/28/2022] Open
Abstract
PURPOSE To analyze the foveal avascular zone (FAZ) in patients with diabetes and no retinopathy vs. controls using OCT angiography (OCT-A). METHODS Prospective, observational clinical study. Type I and II diabetics with no retinopathy and healthy control patients underwent OCT-A. The FAZ size and capillary density were calculated using Image J and Adobe Photoshop CS8. Statistical analysis was performed using one-way ANOVA with Tukey's multiple comparison test and the Pearson correlation test. RESULTS Fifty-two eyes of 28 diabetic patients and 28 eyes of 16 healthy controls were enrolled. Type I diabetes patients had a longer disease duration than type II (30.3 ± 10.3 vs. 12.3 ± 9.7 years). The mean superficial capillary plexus (SCP) of the FAZ area was 0.27 ± 0.1, 0.36 ± 0.14, and 0.27 ± 0.12 mm2, for the type I, type II, and controls (p = 0.0058) and was significantly larger in type II diabetics (p < 0.05). The mean DCP (deep capillary plexus) FAZ was significantly larger in type II diabetics vs. controls (0.67 ± 0.2 and 0.52 ± 0.16 mm2 respectively) (p < 0.05). Both type I and type II SCP capillary density were significantly lower than the controls (p < 0.05, p < 0.005), and DCP capillary density was significantly lower in type II vs. controls (p < 0.005). CONCLUSIONS Type I patients showed fewer changes in the FAZ than the type II group, although their duration of diabetes was longer. Larger studies are needed to better analyze the differences between type I and type II diabetics.
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Tan B, Chua J, Lin E, Cheng J, Gan A, Yao X, Wong DWK, Sabanayagam C, Wong D, Chan CM, Wong TY, Schmetterer L, Tan GS. Quantitative Microvascular Analysis With Wide-Field Optical Coherence Tomography Angiography in Eyes With Diabetic Retinopathy. JAMA Netw Open 2020; 3:e1919469. [PMID: 31951275 PMCID: PMC6991275 DOI: 10.1001/jamanetworkopen.2019.19469] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Wide-field optical coherence tomographic angiography (OCTA) may provide insights to peripheral capillary dropout in eyes with diabetic retinopathy (DR). OBJECTIVE To describe the diagnostic performance of wide-field OCTA with and without large vessel removal for assessment of DR in persons with diabetes. DESIGN, SETTING, AND PARTICIPANTS This case-control study was performed from April 26, 2018, to April 8, 2019, at a single tertiary eye center in Singapore. Case patients were those with type 2 diabetes for more than 5 years and bilateral DR diagnosed by fundus imaging; control participants included those with no self-reported history of diabetes, a fasting glucose level within the normal range in the past year, and no ocular pathologic findings. A wide-field (12 × 12-mm2) fovea-centered scan was performed using a prototype swept source OCTA system. Retinal microvasculature was examined by separating the angiograms into large vessels, capillaries, and capillary dropout regions. MAIN OUTCOMES AND MEASURES Area under the receiver operating characteristic curve (AUC) for DR severity discrimination using wide-field vascular metrics. Retinal perfusion density (RPD), capillary perfusion density (CPD), large vessel density (LVD), and capillary dropout density (CDD) were calculated. Low-contrast regions were excluded from the calculation. RESULTS A total of 49 eyes in 27 control participants (17 male [63.0%]; mean [SD] age, 59.96 [7.63] years; age range, 44-79 years) and 76 eyes in 47 patients with diabetes (29 male [61.7%]; mean [SD] age, 64.36 [8.08] years; range, 41-79 years) were included. Among eyes in patients with diabetes, 23 were in those with diabetes but no DR, 25 in those with mild nonproliferative DR, and 28 in those with moderate to severe nonproliferative DR. There was no difference in RPD, CPD, LVD, and CDD between the control group and the group with diabetes and no DR. There was a stepwise decrease in RPD, CPD, and CDD in the diabetes with no DR, mild nonproliferative DR, and moderate to severe nonproliferative DR groups, whereas LVD was not associated with DR staging. The nonproliferative DR group had decreased RPD, CPD, and CDD compared with the control group. The CPD had higher AUCs than RPD for discriminating diabetes with nonproliferative DR (combined mild and moderate to severe nonproliferative DR) vs no DM (AUC, 0.92 [95% CI, 0.87-0.98] vs 0.89 [95% CI, 0.83-0.95], P = .01), diabetes with no DR vs mild nonproliferative DR (AUC, 0.81 [95% CI, 0.68-0.94] vs 0.77 [95% CI, 0.64-0.91], P = .18), and mild nonproliferative DR vs moderate to severe nonproliferative DR (AUC, 0.82 [95% CI, 0.71-0.94] vs 0.78 [95% CI, 0.65-0.91], P = .01) but similar AUCs for no DM vs diabetes with no DR. The total perfusion density and CPD in wide-field OCTA had better discriminative power than the central 6 × 6-mm2 field (CPD, 0.89 [95% CI, 0.83-0.95] vs 0.84 [95% CI, 0.77-0.92], P = .06; total perfusion density, 0.93 [95% CI, 0.87-0.98] vs 0.90 [95% CI, 0.83-0.96], P = .06). CONCLUSIONS AND RELEVANCE The findings suggest that wide-field OCTA provides information on microvascular perfusion and may be useful for detecting predominant peripheral capillary dropout in eyes with nonproliferative DR. A vascular selectivity approach excluding the large vessels may improve the discriminative power for different stages of DR.
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Affiliation(s)
- Bingyao Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Singapore Eye Research Institute–Nanyang Technological University Advanced Ocular Engineering (STANCE) Program, Singapore
| | - Jacqueline Chua
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Academic Clinical Program, Duke–National University of Singapore Medical School, Singapore
| | - Emily Lin
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Joyce Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Alfred Gan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Xinwen Yao
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Singapore Eye Research Institute–Nanyang Technological University Advanced Ocular Engineering (STANCE) Program, Singapore
| | - Damon W. K. Wong
- Singapore Eye Research Institute–Nanyang Technological University Advanced Ocular Engineering (STANCE) Program, Singapore
| | | | - Doric Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Choi Mun Chan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Academic Clinical Program, Duke–National University of Singapore Medical School, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Singapore Eye Research Institute–Nanyang Technological University Advanced Ocular Engineering (STANCE) Program, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Ophthalmology, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
- National University Health System, Singapore
| | - Gavin S. Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Academic Clinical Program, Duke–National University of Singapore Medical School, Singapore
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Petrachkov DV, Budzinskaya MV. [Biomarkers of diabetic retinopathy on optical coherence tomography angiography]. Vestn Oftalmol 2020; 136:344-353. [PMID: 32880160 DOI: 10.17116/oftalma2020136042344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Pathogenesis of diabetic retinopathy (DR) is complex and multifactorial, giving rise to a wide range of potential biomarkers - quantitatively and objectively measurable indicators of the biological, pathological processes or pharmacological response to therapy. This non-systemic review is devoted to a vital problem - possibility of using biomarkers acquired with optical coherence tomography angiography (OCTA-biomarkers) in DR. The review examines the qualitative and quantitative indicators obtained using OCTA as potential biomarkers of DR. Of greatest interest is the assessment of diabetic microvascular abnormalities such as microaneurysms, intraretinal microvascular abnormalities, neovascularization and non-perfusion (ischemia) zones. A separate section is devoted to currently well-studied indices reflecting the area and regularity of the foveolar avascular zone, and microcirculation indices such as capillary perfusion density, blood flow indices, fractal dimension of retinal microcirculation vessels, etc. The relationship of OCTA-biomarkers and diabetic macular edema is also discussed. Biomarkers obtained with wide-field OCTA, such as indices quantitatively reflecting ischemia and neovascularization are paid special attention in the review. The problems and solutions associated with the use of OCTA-biomarkers in DR are also considered. In general OCTA-biomarkers in DR are becoming an important tool for screening, diagnosis, monitoring of DR, and for predicting and preventing patients' clinical response to treatment.
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You QS, Wang J, Guo Y, Flaxel CJ, Hwang TS, Huang D, Jia Y, Bailey ST. Detection of Reduced Retinal Vessel Density in Eyes with Geographic Atrophy Secondary to Age-Related Macular Degeneration Using Projection-Resolved Optical Coherence Tomography Angiography. Am J Ophthalmol 2020; 209:206-212. [PMID: 31526797 DOI: 10.1016/j.ajo.2019.09.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 09/09/2019] [Accepted: 09/10/2019] [Indexed: 01/05/2023]
Abstract
PURPOSE To compare retinal vessel density in eyes with geographic atrophy (GA) secondary to age-related macular degeneration (AMD) to age-matched healthy eyes by using projection-resolved optical coherence tomography angiography (PR-OCTA). DESIGN Prospective cross-sectional study. METHODS Study participants underwent macular 3- × 3-mm OCTA scans with spectral domain OCTA. Reflectance-compensated retinal vessel densities were calculated on projection-resolved superficial vascular complex (SVC), intermediate capillary plexus (ICP), and deep capillary plexus (DCP). Quantitative analysis using normalized deviation compared the retinal vessel density in GA regions, 500-μm GA rim regions, and non-GA regions to similar macular locations in control eyes. RESULTS Ten eyes with GA and 10 control eyes were studied. Eyes with GA had significantly lower vessel density in the SVC (54.8 ± 2.4% vs. 60.8 ± 3.1%; P < 0.001), ICP (34.0 ± 1.5% vs. 37.3 ± 1.7%; P = 0.003) and DCP (24.4 ± 2.3% vs. 28.0 ± 2.3%; P < 0.001) than control eyes. Retinal vessel density within the GA region decreased significantly in SVC, ICP, and DCP. Retinal vessel density in the GA rim region decreased in SVC and ICP but not in DCP. The non-GA region did not significantly deviate from normal controls. Eyes with GA had significantly reduced photoreceptor layer thickness; but similar nerve fiber layer, ganglion cell complex, inner nuclear layer, and outer plexiform layer thickness. CONCLUSIONS Eyes with GA have reduced retinal vessel density in SVC, ICP, and DCP compared to those in controls. Loss is greatest within regions of GA. Vessel density may be more sensitive than retinal layer thickness measurement in the detection of inner retinal change in eyes with GA.
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Affiliation(s)
- Qi Sheng You
- Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Jie Wang
- Department of Biomedical Engineering, Oregon Health and Science University, Portland, Oregon, USA
| | - Yukun Guo
- Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Christina J Flaxel
- Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Thomas S Hwang
- Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - David Huang
- Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Yali Jia
- Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, USA; Department of Biomedical Engineering, Oregon Health and Science University, Portland, Oregon, USA
| | - Steven T Bailey
- Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, USA.
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Diabetic Macular Edema: State of Art and Intraocular Pharmacological Approaches. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1307:375-389. [PMID: 32488606 DOI: 10.1007/5584_2020_535] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Diabetic macular edema (DME) is the main cause of vision loss in diabetic retinopathy (DR). Although it is one of the main complications of diabetes, the pathogenesis of DME is not completely understood. The hyperglycemic state promotes the activation of multiple interlinked pathways leading to DME. Different classifications have been proposed: based on clinical features, on pathogenesis or on diagnostic tests (optical coherence tomography - OCT and fluorescin angiography - FA). The multimodal imaging allows a better analysis of the morphological features of the DME. Indeed, new inflammatory biomarkers have been identified on OCT. Also, several studies are evaluating the role of the morphological features, identified on multimodal imaging, to find new prognostic factors. Over the past decade, great progresses have been made in the management of DME. Therapeutic alternatives include intraocular injection of anti-vascular endothelial grow factor agents (anti-VEGF) and steroid molecules, focal/grid laser photocoagulation and vitreo-retinal surgery. This review is focused on the description and analysis of the current intravitreal therapeutic pharmacological strategies. Current guidelines recommend anti-VEGF as first line therapy in DME. Corticosteroids are becoming increasingly relevant blocking the inflammatory cascade and indirectly reducing VEGF synthesis.
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130
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Jian G, Jing XY, Yang L, Lun L. Quantitative Analysis of Foveal Microvascular Differences in Diabetic Macular Edema with and without Subfoveal Neuroretinal Detachment. J Diabetes Res 2020; 2020:2582690. [PMID: 32185235 PMCID: PMC7063210 DOI: 10.1155/2020/2582690] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 01/31/2020] [Accepted: 02/14/2020] [Indexed: 11/17/2022] Open
Abstract
PURPOSE This study is aimed at quantifying the difference of the foveal microvasculature in the eyes with diabetic macular edema (DME) with and without subfoveal neuroretinal detachment (SND+ and SND-, respectively). METHODS This retrospective, cross-sectional study included 48 eyes from 42 patients with DME (20 SND+ and 28 SND- eyes). Data collection included fundus color photographs, optical coherence tomography angiography (OCTA), and best-corrected visual acuity. The following parameters were evaluated with OCTA: foveal avascular zone (FAZ) parameters and vessel density in a width of 300 μm around the FAZ, superficial capillary plexus, deep capillary plexus (DCP), and choriocapillary plexus. The number of retinal hyperreflective spots (HRS) and the area of SND in the central 3 mm were evaluated at 0 degrees using B-scans. RESULTS Parafoveal vessel densities of DCP were significantly lower in SND+ than in SND- eyes (p < 0.001). The number of HRS was significantly higher in SND+ than in SND- eyes (p < 0.001). The number of HRS was significantly higher in SND+ than in SND- eyes (r = 0.389, p < 0.001). The number of HRS was significantly higher in SND+ than in SND- eyes (. CONCLUSION DME with SND correlated with larger numbers of HRS and significant macular microvascular impairment in the DCP. The pathophysiology of decline of parafoveal vessel density in the DCP with an increase in the number of HRS in the eyes with DME with SND needs further investigation.
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Affiliation(s)
- Gao Jian
- Department of Ophthalmology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Xu Ya Jing
- Department of Ophthalmology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Li Yang
- Department of Ophthalmology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Liu Lun
- Department of Ophthalmology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
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Göker YŞ, Kızıltoprak H, Tekin K, Yetkin E, Karatepe MS, Özdemir K, Demir G. Direct and crossover effects of Phenylephrine and Cyclopentolate on foveal avascular zone and vessel density of macular capillary plexuses: an optical coherence tomography angiography study. Rom J Ophthalmol 2020; 64:195-204. [PMID: 32685787 PMCID: PMC7339688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Purpose: To determine the influence of phenylephrine and cyclopentolate on foveal avascular zone (FAZ) and vessel density of macular capillary plexus measurements via optical coherence tomography angiography (OCTA). Materials and Methods: The participants were separated into 2 groups according to the administration of drops. One drop of phenylephrine 2.5% was administered on one eye of each subject in the phenylephrine group (n=30) and one drop of cyclopentolate 1% in the cyclopentolate group (n=30). FAZ parameters and vessel density values of both superficial (SCP) and deep capillary plexuses (DCP) were calculated via OCTA priorly and at 45 min following the drop administration in both eyes. Vessel density, acircularity index of FAZ, FAZ area, perimeter of FAZ and foveal density-300 were evaluated via OCTA. Results: The vessel density values of fovea in SCP and DCP was 18.51±7.14% and 36.05±8.76% and significantly decreased to 16.16±6.26% and 33.29±9.47% respectively after drop instillation in dilated eyes in phenylephrine group (p=0.041 and p=0.032). Likewise, the vessel density values in SCP and DCP were 21.56±7.74% and 39.27±8.76% and significantly decreased to 18.89±7.32% and 35.36±5.75% respectively, after drop instillation in dilated eyes in cyclopentolate group (p=0.035 and p=0.028). However, there was no significant difference between before and after instillation of drops in terms of foveal density-300 value via FAZ assessment tool in both dilated and nondilated contralateral eyes in both groups (p>0.05 for all). Conclusions: Mydriasis with phenylephrine and/ or cyclopentolate did not affect the foveal density-300 values while analyzing the perfusion of macula. Vessel density in foveal region should be evaluated via FAZ evaluation software of the OCTA.
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Affiliation(s)
| | | | - Kemal Tekin
- Ercis State Hospital, Ophthalmology Department, Van, Turkey
| | - Esat Yetkin
- Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | | | - Kübra Özdemir
- Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Gokhan Demir
- Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
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Wang J, Hormel TT, You Q, Guo Y, Wang X, Chen L, Hwang TS, Jia Y. Robust non-perfusion area detection in three retinal plexuses using convolutional neural network in OCT angiography. BIOMEDICAL OPTICS EXPRESS 2020; 11:330-345. [PMID: 32010520 PMCID: PMC6968759 DOI: 10.1364/boe.11.000330] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/27/2019] [Accepted: 12/01/2019] [Indexed: 05/22/2023]
Abstract
Non-perfusion area (NPA) is a quantitative biomarker useful for characterizing ischemia in diabetic retinopathy (DR). Projection-resolved optical coherence tomographic angiography (PR-OCTA) allows visualization of retinal capillaries and quantify NPA in individual plexuses. However, poor scan quality can make current NPA detection algorithms unreliable and inaccurate. In this work, we present a robust NPA detection algorithm using convolutional neural network (CNN). By merging information from OCT angiograms and OCT reflectance images, the CNN could exclude signal reduction and motion artifacts and detect the avascular features from local to global with the resolution preserved. Across a wide range of signal strength indices, and on both healthy and DR eyes, the algorithm achieved high accuracy and repeatability.
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Affiliation(s)
- Jie Wang
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 97239, USA
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR 97239, USA
| | - Tristan T. Hormel
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - Qisheng You
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - Yukun Guo
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | | | - Liu Chen
- Department of Computer Science & Electrical Engineering, Oregon Health & Science University, Portland, OR 97239, USA
| | - Thomas S. Hwang
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - Yali Jia
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 97239, USA
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR 97239, USA
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133
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Ciloglu E, Unal F, Sukgen EA, Koçluk Y. Evaluation of Foveal Avascular Zone and Capillary Plexuses in Diabetic Patients by Optical Coherence Tomography Angiography. KOREAN JOURNAL OF OPHTHALMOLOGY 2019; 33:359-365. [PMID: 31389212 PMCID: PMC6685831 DOI: 10.3341/kjo.2018.0025] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 04/30/2018] [Accepted: 05/17/2018] [Indexed: 01/07/2023] Open
Abstract
Purpose To investigate the foveal avascular zone (AVZ), superficial and deep foveal and parafoveal vessel density (VD) changes related to diabetic retinopathy. Methods Forty-nine type 2 diabetes mellitus (DM) and 45 healthy control subjects were included in this study. The demographic data (age and sex), disease duration, and level of glycated hemoglobin were collected. Superficial VD (%), superficial AVZ area (mm2), deep VD (%) and deep AVZ area (mm2) were evaluated via optic coherence tomography angiography. Results Superficial AVZ was 0.438 ± 0.05 mm2 in the DM group, 0.246 ± 0.022 mm2 in the control group (p < 0.001). Deep AVZ was 0.732 ± 0.06 mm2 in the DM group, and 0.342 ± 0.022 mm2 in the control group (p < 0.001). Superficial foveal VD was 29.45 ± 0.76 mm2 in the DM group, and 34.86 ± 0.75 mm2 in the control group (p < 0.001). Deep foveal VD was 24.85 ± 1.08 mm2 in the DM group, and 33.47 ± 0.56 mm2 in the control group (p < 0.001). Conclusions In this study, we demonstrated an enlargement in the foveal AVZ along with a reduction in the vascular density of the superficial and deep capillary network in the foveal and parafoveal area using optic coherence tomography angiography in patients with nonproliferative diabetic retinopathy. This technique can be used to monitor the progression of the disease and to evaluate the response to treatment.
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Affiliation(s)
- Emine Ciloglu
- Department of Ophthalmology, Adana Training and Research City Hospital, Adana, Turkey.
| | - Fikret Unal
- Department of Ophthalmology, Adana Training and Research City Hospital, Adana, Turkey
| | - Emine Alyamaç Sukgen
- Department of Ophthalmology, Adana Training and Research City Hospital, Adana, Turkey
| | - Yusuf Koçluk
- Department of Ophthalmology, Adana Training and Research City Hospital, Adana, Turkey
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Sun Z, Tang F, Wong R, Lok J, Szeto SKH, Chan JCK, Chan CKM, Tham CC, Ng DS, Cheung CY. OCT Angiography Metrics Predict Progression of Diabetic Retinopathy and Development of Diabetic Macular Edema: A Prospective Study. Ophthalmology 2019; 126:1675-1684. [PMID: 31358386 DOI: 10.1016/j.ophtha.2019.06.016] [Citation(s) in RCA: 176] [Impact Index Per Article: 35.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 06/03/2019] [Accepted: 06/17/2019] [Indexed: 02/02/2023] Open
Abstract
PURPOSE To prospectively determine the relationship of OCT angiography (OCTA) metrics to diabetic retinopathy (DR) progression and development of diabetic macular edema (DME). DESIGN Prospective, observational study. PARTICIPANTS A total of 205 eyes from 129 patients with diabetes mellitus followed up for at least 2 years. METHODS All participants underwent OCTA with a swept-source OCT device (DRI-OCT Triton, Topcon, Inc, Tokyo, Japan). Individual OCTA images of superficial capillary plexus (SCP) and deep capillary plexus (DCP) were generated by IMAGEnet6 (Basic License 10). After a quality check, automated measurements of foveal avascular zone (FAZ) area, FAZ circularity, vessel density (VD), and fractal dimension (FD) of both SCP and DCP were then obtained. MAIN OUTCOME MEASURES Progression of DR and development of DME. RESULTS Over a median follow-up of 27.14 months (interquartile range, 24.16-30.41 months), 28 of the 205 eyes (13.66%) developed DR progression. Of the 194 eyes without DME at baseline, 17 (8.76%) developed DME. Larger FAZ area (hazard ratio [HR], 1.829 per SD increase; 95% confidence interval [CI], 1.332-2.512), lower VD (HR, 1.908 per SD decrease; 95% CI, 1.303-2.793), and lower FD (HR, 4.464 per SD decrease; 95% CI, 1.337-14.903) of DCP were significantly associated with DR progression after adjusting for established risk factors (DR severity, glycated hemoglobin, duration of diabetes, age, and mean arterial blood pressure at baseline). Lower VD of SCP (HR, 1.789 per SD decrease; 95% CI, 1.027-4.512) was associated with DME development. Compared with the model with established risk factors alone, the addition of OCTA metrics improved the predictive discrimination of DR progression (FAZ area of DCP, C-statistics 0.723 vs. 0.677, P < 0.001; VD of DCP, C-statistics 0.727 vs. 0.677, P = 0.001; FD of DCP, C-statistics 0.738 vs. 0.677, P < 0.001) and DME development (VD of SCP, C-statistics 0.904 vs. 0.875, P = 0.036). CONCLUSIONS The FAZ area, VD, and FD of DCP predict DR progression, whereas VD of SCP predicts DME development. Our findings provide evidence to support that OCTA metrics improve the evaluation of risk of DR progression and DME development beyond traditional risk factors.
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Affiliation(s)
- Zihan Sun
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Fangyao Tang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Raymond Wong
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China
| | - Jerry Lok
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China
| | - Simon K H Szeto
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China
| | - Jason C K Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China
| | - Carmen K M Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Danny S Ng
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
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PRESENCE OF PERIPHERAL LESIONS AND CORRELATION TO MACULAR PERFUSION, OXYGENATION AND NEURODEGENERATION IN EARLY TYPE II DIABETIC RETINAL DISEASE. Retina 2019; 40:1964-1971. [DOI: 10.1097/iae.0000000000002704] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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136
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Zarranz-Ventura J, Barraso M, Alé-Chilet A, Hernandez T, Oliva C, Gascón J, Sala-Puigdollers A, Figueras-Roca M, Vinagre I, Ortega E, Esmatjes E, Adan A. Evaluation of microvascular changes in the perifoveal vascular network using optical coherence tomography angiography (OCTA) in type I diabetes mellitus: a large scale prospective trial. BMC Med Imaging 2019; 19:91. [PMID: 31752726 PMCID: PMC6873669 DOI: 10.1186/s12880-019-0391-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 10/25/2019] [Indexed: 02/01/2023] Open
Abstract
Background Diabetic retinopathy (DR) is the leading cause of blindness in type 1 Diabetes Mellitus (DM) patients, as a consequence of impaired blood flow in the retina. Optical coherence tomography angiography (OCTA) is a newly developed, non-invasive, retinal imaging technique that permits adequate delineation of the perifoveal vascular network. It allows the detection of paramacular areas of capillary non perfusion and/or enlargement of the foveal avascular zone (FAZ), representing an excellent tool for assessment of DR. The relationship of these microvascular changes with systemic factors such as metabolic control or duration of the disease still needs to be elucidated. Methods Prospective, consecutive, large-scale OCTA study. A complete ocular examination including a comprehensive series of OCTA images of different scan sizes captured with 2 OCT devices (Cirrus HD-OCT, Carl Zeiss Meditec, Dublin, CA, USA, and Triton Deep Range Imaging OCT, Topcon Corp, Topcon, Japan) will be obtained as part of the yearly routine follow up visits in type 1 DM patients seen in the Diabetes Unit of the Endocrinology department which give written informed consent to participate in the project. The aim of this study is to investigate the relationship between OCTA-derived parameters and systemic factors, as metabolic control (Hb1Ac, lipid profile, cholesterol, etc), and other relevant clinical factors as demographics or duration of the disease. Discussion This study is directed to investigate the relationship between the status of the perifoveal vascular network and systemic markers of the disease, and in particular to study whether these changes reflect those occurring elsewhere in the body affected by diabetic microvascular disease, as the kidneys or the brain. If these relationships were demonstrated, early detection of these microvascular changes by OCTA could lead to modifications in the pharmacological management of type 1 diabetic patients, as a way to reduce the risk of future complications in both the eye and other organs. Trial registration ClinicalTrials.gov, trial number NCT03422965.
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Affiliation(s)
- Javier Zarranz-Ventura
- Institut Clínic d'Oftalmología (ICOF), Hospital Clinic de Barcelona, C/ Sabino Arana 1, 08028, Barcelona, Spain. .,Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
| | - Marina Barraso
- Institut Clínic d'Oftalmología (ICOF), Hospital Clinic de Barcelona, C/ Sabino Arana 1, 08028, Barcelona, Spain
| | - Anibal Alé-Chilet
- Institut Clínic d'Oftalmología (ICOF), Hospital Clinic de Barcelona, C/ Sabino Arana 1, 08028, Barcelona, Spain
| | - Teresa Hernandez
- Institut Clínic d'Oftalmología (ICOF), Hospital Clinic de Barcelona, C/ Sabino Arana 1, 08028, Barcelona, Spain
| | - Cristian Oliva
- Institut Clínic d'Oftalmología (ICOF), Hospital Clinic de Barcelona, C/ Sabino Arana 1, 08028, Barcelona, Spain
| | - Jesus Gascón
- Institut Clínic d'Oftalmología (ICOF), Hospital Clinic de Barcelona, C/ Sabino Arana 1, 08028, Barcelona, Spain
| | - Anna Sala-Puigdollers
- Institut Clínic d'Oftalmología (ICOF), Hospital Clinic de Barcelona, C/ Sabino Arana 1, 08028, Barcelona, Spain.,Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Marc Figueras-Roca
- Institut Clínic d'Oftalmología (ICOF), Hospital Clinic de Barcelona, C/ Sabino Arana 1, 08028, Barcelona, Spain.,Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Irene Vinagre
- Diabetes Unit, Institut Clínic de Malalties Digestives i Metaboliques (ICMDM), Hospital Clinic de Barcelona, Barcelona, Spain
| | - Emilio Ortega
- Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Diabetes Unit, Institut Clínic de Malalties Digestives i Metaboliques (ICMDM), Hospital Clinic de Barcelona, Barcelona, Spain
| | - Enric Esmatjes
- Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Diabetes Unit, Institut Clínic de Malalties Digestives i Metaboliques (ICMDM), Hospital Clinic de Barcelona, Barcelona, Spain
| | - Alfredo Adan
- Institut Clínic d'Oftalmología (ICOF), Hospital Clinic de Barcelona, C/ Sabino Arana 1, 08028, Barcelona, Spain.,Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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137
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Laotaweerungsawat S, Psaras C, Liu X, Stewart JM. OCT Angiography Assessment of Retinal Microvascular Changes in Diabetic Eyes in an Urban Safety-Net Hospital. Ophthalmol Retina 2019; 4:425-432. [PMID: 31926950 DOI: 10.1016/j.oret.2019.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 11/07/2019] [Accepted: 11/08/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE To determine whether quantitative OCT angiography (OCTA) parameters can be used to distinguish among eyes at various stages of diabetic retinopathy (DR) in an urban safety-net hospital population. DESIGN Prospective cross-sectional study. PARTICIPANTS Three hundred twenty-nine eyes from 329 patients were included in this study: 90 nondiabetic patients, 170 diabetic patients without DR, 57 diabetic patients with mild to moderate nonproliferative DR (NPDR), and 12 diabetic patients with severe NPDR to proliferative DR. METHODS Patients underwent OCTA imaging and ultra-widefield fundus photography at Zuckerberg San Francisco General Hospital and Trauma Center between April and October 2018. For participants with diabetes, imaging was classified according to DR severity by a telemedicine reading center. Eight OCTA parameters were analyzed. Perfusion density and vessel length density (VD) were examined from both the superficial capillary plexus (SCP) and deep capillary plexus. The other 4 parameters were examined only from the SCP. Total extrafoveal avascular area (tEAA) was based on the area of absent capillary vessels. Foveal avascular zone (FAZ)-related metrics consisted of FAZ area, FAZ circularity index, and FAZ acircularity index. MAIN OUTCOME MEASURES Area under the receiver operating characteristic curve (AUC) for OCTA parameters to distinguish among groups according to DR severity. RESULTS All OCTA parameters demonstrated a significant relationship with DR severity (P < 0.05). No significant difference was found when comparing nondiabetic participants versus diabetic participants without retinopathy. The FAZ area was the only metric that demonstrated a significant difference between genders: mean of 0.29±0.12 mm2 in men and 0.34±0.13 mm2 in women (P < 0.001). Receiver operating characteristic curve analyses showed that tEAA had the highest AUC when comparing various stages of the disease. CONCLUSIONS In this urban, public hospital population, quantification of retinal vascular findings with OCTA imaging was a useful means of distinguishing patients according to DR severity. Because these results were similar to those of other tertiary referral centers, it would be reasonable to perform further DR-related OCTA studies in this population and expect generalizable results.
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Affiliation(s)
- Sawarin Laotaweerungsawat
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California; Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California; Department of Ophthalmology, Charoenkrung Pracharak Hospital, Bangkok, Thailand
| | - Catherine Psaras
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California; Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | - Xiuyun Liu
- Department of Physiological Nursing, University of California, San Francisco, San Francisco, California
| | - Jay M Stewart
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California; Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California.
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138
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Ali N, Sampson DM, Au Yong A, Jeewa R, Rajgopal S, Dutt DDCS, Mohamed S, Mohamed S, Menghini M, Hansen A, Chen FK. Clinical validation of the RTVue optical coherence tomography angiography image quality indicators. Clin Exp Ophthalmol 2019; 48:192-203. [PMID: 31705836 DOI: 10.1111/ceo.13680] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 10/20/2019] [Accepted: 11/06/2019] [Indexed: 11/29/2022]
Abstract
IMPORTANCE All automated image quality indicators for en face optical coherence tomography angiography (OCTA) images require gold standard validation for determining optimum thresholds. BACKGROUND A manual grading system (gold standard) for OCTA images was validated and compared to two automated image quality indicators: signal strength index (SSI) and scan quality index (SQI) generated by different software versions of the Optovue OCTA device. DESIGN Retrospective cross-sectional study. PARTICIPANTS A total of 52 eyes of 52 healthy individual and 77 eyes of 51 patients with retinal vascular diseases. METHODS A total of 129 OCTA images of the superficial vascular plexus were graded manually by three independent examiners. Each image was assigned grades 1 to 4 (1-2, unacceptable; 3-4, acceptable) masked to the software-generated quality indicators. MAIN OUTCOME MEASURES Inter-grader agreement and comparison of the utility of SSI and SQI in discriminating between acceptable and unacceptable OCTA images. RESULTS There was a substantial agreement between the three graders (κ = 0.63). Mean SSI and SQI was significantly different between acceptable and unacceptable images (P < .001). SQI outperformed SSI in separating acceptable from unacceptable images (areas under the receiver operating characteristic curve: 0.87 vs 0.80) and the optimum cut-off was ≥7 for SQI and ≥70 for SSI for acceptable images. Up to 30% of images with quality indicators reaching the optimum SQI and SSI cut-off thresholds still had unacceptable quality on manual grading. Unacceptable images were found in 33% and 66% of healthy and diseased eyes, respectively. CONCLUSIONS AND RELEVANCE SQI is closely related to manual grading but we caution reliance on the optimized threshold to determine image quality. SQI is superior to SSI in discriminating between acceptable and unacceptable images.
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Affiliation(s)
- Noha Ali
- Centre for Ophthalmology and Visual Science (Incorporating Lions Eye Institute), The University of Western Australia, Perth, Western Australia, Australia.,Department of Ophthalmology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Danuta M Sampson
- Centre for Ophthalmology and Visual Science (Incorporating Lions Eye Institute), The University of Western Australia, Perth, Western Australia, Australia.,Surrey Biophotonics, Centre for Vision, Speech and Signal Processing and School of Biosciences and Medicine, The University of Surrey, Guildford, UK
| | - Alex Au Yong
- Centre for Ophthalmology and Visual Science (Incorporating Lions Eye Institute), The University of Western Australia, Perth, Western Australia, Australia
| | - Rumaanah Jeewa
- Centre for Ophthalmology and Visual Science (Incorporating Lions Eye Institute), The University of Western Australia, Perth, Western Australia, Australia
| | - Saumya Rajgopal
- Centre for Ophthalmology and Visual Science (Incorporating Lions Eye Institute), The University of Western Australia, Perth, Western Australia, Australia
| | - Deepaysh D C S Dutt
- Centre for Ophthalmology and Visual Science (Incorporating Lions Eye Institute), The University of Western Australia, Perth, Western Australia, Australia
| | - Sharaf Mohamed
- Department of Ophthalmology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Shehata Mohamed
- Department of Ophthalmology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Moreno Menghini
- Department of Ophthalmology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Alex Hansen
- Department of Ophthalmology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Fred K Chen
- Centre for Ophthalmology and Visual Science (Incorporating Lions Eye Institute), The University of Western Australia, Perth, Western Australia, Australia.,Department of Ophthalmology, Royal Perth Hospital, Perth, Western Australia, Australia
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139
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Wang F, Saraf SS, Zhang Q, Wang RK, Rezaei KA. Ultra-Widefield Protocol Enhances Automated Classification of Diabetic Retinopathy Severity with OCT Angiography. Ophthalmol Retina 2019; 4:415-424. [PMID: 31982390 DOI: 10.1016/j.oret.2019.10.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 10/25/2019] [Accepted: 10/31/2019] [Indexed: 12/24/2022]
Abstract
PURPOSE To assess the diagnostic usefulness of retinal nonperfusion to classify eyes based on diabetic retinopathy (DR) severity on OCT angiography (OCTA) and determine whether wider field of view (FOV) OCTA protocols enhance the diagnostic usefulness of retinal nonperfusion in the classification of DR severity. DESIGN Retrospective cross-sectional study. PARTICIPANTS Diabetic patients undergoing ultra-widefield (UWF) OCTA imaging at 1 academic retina practice. METHODS Ultra-widefield OCTA images with 100° FOV were obtained from 60 eyes. Eyes were grouped as those with diabetes without retinopathy (DWR), those with nonproliferative diabetic retinopathy (NPDR), or those with proliferative diabetic retinopathy (PDR). The ratio of nonperfusion (RNP) was expressed as the percent area of capillary nonperfusion within the FOV. The RNP was obtained in the FOV 100° image and concentric sectors encompassing 10°, 10° to 30°, 30° to 50°, and 50° to 100°. MAIN OUTCOME MEASURES Mean RNP among DR groups, mean RNP measured among FOV sectors, and area under the curve (AUC) of the receiver operating characteristics when using RNP as a cutoff value to distinguish between DR groups. RESULTS Mean RNP from the FOV 50° to 100° sector was different among all groups: DWR, 14.6±5.1%; NPDR, 27.5±7.5%; and PDR, 41.5±19.1% (P < 0.01). Within each DR group, field of view from 50° to 100° measured higher RNP than all other sectors (P < 0.01). Field of view from 50° to 100° showed the highest optimal sensitivity and specificity to distinguish NPDR from DWR with an RNP cutoff value of 21.2% (89.5% and 88.2%; AUC, 0.944) and PDR from NPDR with an RNP cutoff value of 31.6% (79.2% and 78.9%; AUC, 0.752). CONCLUSIONS Ratio of nonperfusion on average is higher in more severe DR. The most peripheral sector of the widefield OCTA (FOV 50°-100°) showed on average higher RNP and showed more diagnostic usefulness in determining DR severity compared with more central sectors and the FOV 100 image as a whole.
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Affiliation(s)
- FuPeng Wang
- Department of Bioengineering, University of Washington, Seattle, Washington; College of Information Science and Engineering, Ocean University of China, Qingdao, China
| | - Steven S Saraf
- Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Qinqin Zhang
- Department of Bioengineering, University of Washington, Seattle, Washington
| | - Ruikang K Wang
- Department of Bioengineering, University of Washington, Seattle, Washington; Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Kasra A Rezaei
- Department of Ophthalmology, University of Washington, Seattle, Washington.
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Nagasato D, Tabuchi H, Masumoto H, Enno H, Ishitobi N, Kameoka M, Niki M, Mitamura Y. Automated detection of a nonperfusion area caused by retinal vein occlusion in optical coherence tomography angiography images using deep learning. PLoS One 2019; 14:e0223965. [PMID: 31697697 PMCID: PMC6837754 DOI: 10.1371/journal.pone.0223965] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 10/02/2019] [Indexed: 11/18/2022] Open
Abstract
We aimed to assess the ability of deep learning (DL) and support vector machine (SVM) to detect a nonperfusion area (NPA) caused by retinal vein occlusion (RVO) with optical coherence tomography angiography (OCTA) images. The study included 322 OCTA images (normal: 148; NPA owing to RVO: 174 [128 branch RVO images and 46 central RVO images]). Training to construct the DL model using deep convolutional neural network (DNN) algorithms was provided using OCTA images. The SVM used a scikit-learn library with a radial basis function kernel. The area under the curve (AUC), sensitivity and specificity for detecting an NPA were examined. We compared the diagnostic ability (sensitivity, specificity and average required time) between the DNN, SVM and seven ophthalmologists. Heat maps were generated. With regard to the DNN, the mean AUC, sensitivity, specificity and average required time for distinguishing RVO OCTA images with an NPA from normal OCTA images were 0.986, 93.7%, 97.3% and 176.9 s, respectively. With regard to SVM, the mean AUC, sensitivity, and specificity were 0.880, 79.3%, and 81.1%, respectively. With regard to the seven ophthalmologists, the mean AUC, sensitivity, specificity and average required time were 0.962, 90.8%, 89.2%, and 700.6 s, respectively. The DNN focused on the foveal avascular zone and NPA in heat maps. The performance of the DNN was significantly better than that of SVM in all parameters (p < 0.01, all) and that of the ophthalmologists in AUC and specificity (p < 0.01, all). The combination of DL and OCTA images had high accuracy for the detection of an NPA, and it might be useful in clinical practice and retinal screening.
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Affiliation(s)
- Daisuke Nagasato
- Department of Ophthalmology, Tsukazaki Hospital, Himeji, Japan
- * E-mail:
| | - Hitoshi Tabuchi
- Department of Ophthalmology, Tsukazaki Hospital, Himeji, Japan
| | - Hiroki Masumoto
- Department of Ophthalmology, Tsukazaki Hospital, Himeji, Japan
| | | | | | | | - Masanori Niki
- Department of Ophthalmology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Yoshinori Mitamura
- Department of Ophthalmology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
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Russell JF, Flynn HW, Sridhar J, Townsend JH, Shi Y, Fan KC, Scott NL, Hinkle JW, Lyu C, Gregori G, Russell SR, Rosenfeld PJ. Distribution of Diabetic Neovascularization on Ultra-Widefield Fluorescein Angiography and on Simulated Widefield OCT Angiography. Am J Ophthalmol 2019; 207:110-120. [PMID: 31194952 DOI: 10.1016/j.ajo.2019.05.031] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 05/29/2019] [Accepted: 05/31/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE Areas of neovascularization (NV) in proliferative diabetic retinopathy (PDR) on ultra-widefield (UWF) fluorescein angiography (FA) were identified and compared with a simulated widefield (WF) swept-source OCT angiography (SS-OCTA) field of view to determine whether the WF SS-OCTA field of view was sufficient for detection of NV in PDR. DESIGN Retrospective, consecutive case series. METHODS All patients with PDR and UWF FA imaging at the Bascom Palmer Eye Institute over a period of 5.5 years were identified. UWF FA images were reviewed and sites of NV were identified either as NV of the disc or NV elsewhere. Sites of NV elsewhere were classified by disc-centered retinal quadrants. A simulated WF SS-OCTA montage field of view was overlaid on the UWF FA images to determine whether sites of NV would have been identified by this simulated WF SS-OCTA field of view. RESULTS A total of 651 eyes with PDR from 433 patients had at least 1 UWF FA with NV. Of the 651 eyes, 50% were treatment-naïve, 9.8% had NV of the disc only, 41.8% had NV elsewhere only, and 48.4% had both NV of the disc and NV elsewhere. NV elsewhere was most prevalent in the superotemporal quadrant and the least prevalent in the nasal quadrants. When the simulated WF SS-OCTA field of view was overlaid on the UWF FA, 98.3% of all eyes, 99.4% of treatment-naive eyes, and 97.2% of previously treated eyes had NV within the WF SS-OCTA field of view. In those eyes with a repeat UWF FA within 6 to 18 months of the first FA, the distribution of NV did not change in either the treatment-naive or previously treated eyes. CONCLUSIONS NV elsewhere in PDR was most prevalent superotemporally, and 99.4% of treatment-naïve eyes had NV within the simulated WF SS-OCTA field of view. Combined with previous research using WF SS-OCTA to identify NV in PDR, these findings suggest that WF SS-OCTA may be the only imaging modality needed for the diagnosis and longitudinal management of PDR.
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Affiliation(s)
- Jonathan F Russell
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jayanth Sridhar
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Justin H Townsend
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Yingying Shi
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Kenneth C Fan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Nathan L Scott
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - John W Hinkle
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Cancan Lyu
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Giovanni Gregori
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Stephen R Russell
- Department of Ophthalmology and Visual Sciences, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Philip J Rosenfeld
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA.
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Hwang TS, Hagag AM, Wang J, Zhang M, Smith A, Wilson DJ, Huang D, Jia Y. Automated Quantification of Nonperfusion Areas in 3 Vascular Plexuses With Optical Coherence Tomography Angiography in Eyes of Patients With Diabetes. JAMA Ophthalmol 2019; 136:929-936. [PMID: 29902297 DOI: 10.1001/jamaophthalmol.2018.2257] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Importance Diabetic retinopathy (DR) is a leading cause of vision loss that is managed primarily through qualitative clinical examination of the retina. Optical coherence tomography angiography (OCTA) may offer an objective and quantitative method of evaluating DR. Objective To quantify capillary nonperfusion in 3 vascular plexuses in the macula of eyes patients with diabetes of various retinopathy severity using projection-resolved OCTA (PR-OCTA). Design, Setting, and Participants Cross-sectional study at a tertiary academic center comprising 1 eye each from healthy control individuals and patients with diabetes at different severity stages of retinopathy. Data were acquired and analyzed between January 2015 and December 2017. Main Outcomes and Measures Foveal avascular zone area, extrafoveal avascular area (EAA), and the sensitivity of detecting levels of retinopathy. Results The study included 39 control individuals (20 women [51%]; mean [SD] age, 43.41 [19.37] years); 16 patients with diabetes without retinopathy (8 women [50%]; mean [SD] age, 56.50 [12.43] years); 23 patients with mild to moderate nonproliferative DR (18 women [78%] ; mean [SD] age, 62.48 [10.55] years); and 32 patients with severe nonproliferative DR or proliferative DR (12 women [38%]; mean age, 53.41 [14.05] years). Mean (SD) foveal avascular zone area was 0.203 (0.103) mm2 for control individuals, 0.192 (0.084) mm2 for patients with diabetes without retinopathy, 0.243 [0.079] mm2 for mild to moderate nonproliferative DR, and 0.359 (0.275) mm2 for severe nonproliferative DR or proliferative DR. Mean (SD) EAA in whole inner retinal slab in these groups, respectively, were 0.020 (0.031) mm2, 0.034 (0.047) mm2, 0.038 (0.040) mm2, and 0.237 (0.235) mm2. The mean (SD) sum of EAA from 3 segmented plexuses in each of the respective groups were 0.103 (0.169) mm2, 0.213 (0.242) mm2, 0.451 (0.243) mm2, and 1.325 (1.140) mm2. With specificity fixed at 95%, using EAA in inner retinal slab, the sensitivity of detecting patients with diabetes from healthy control individuals was 28% (95% CI, 18%-40%), 31% for patients with DR (95% CI, 19%-45%), and 47% for patients with severe DR (95% CI, 29%-65%) from whole inner retinal EAA. With the sum of EAA from 3 individual plexuses, the sensitivities were 69% (95% CI, 57%-80%), 82% (95% CI, 70%-91%), and 97% (95% CI, 85%-100%), respectively. Avascular areas were not associated with signal strength index. The commercial vessel density from the 2-plexus scheme distinguished the groups with lower sensitivity and were dependent on SSI. Conclusions and Relevance Automatically quantified avascular areas from a 3-layer segmentation scheme using PR-OCTA distinguished levels of retinopathy with a greater sensitivity than avascular areas from unsegmented inner retinal slab or measurements from a commercially available vessel density in 2-layer scheme. Additional studies are needed to investigate the applicability of nonperfusion parameters in clinical settings.
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Affiliation(s)
- Thomas S Hwang
- Casey Eye Institute, Oregon Health and Science University, Portland
| | - Ahmed M Hagag
- Casey Eye Institute, Oregon Health and Science University, Portland
| | - Jie Wang
- Casey Eye Institute, Oregon Health and Science University, Portland
| | - Miao Zhang
- Casey Eye Institute, Oregon Health and Science University, Portland.,Optovue Inc, Fremont, California
| | - Andrew Smith
- Casey Eye Institute, Oregon Health and Science University, Portland.,Georgetown University School of Medicine, Washington, DC
| | - David J Wilson
- Casey Eye Institute, Oregon Health and Science University, Portland
| | - David Huang
- Casey Eye Institute, Oregon Health and Science University, Portland
| | - Yali Jia
- Casey Eye Institute, Oregon Health and Science University, Portland
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143
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Brücher VC, Storp JJ, Kerschke L, Nelis P, Eter N, Alnawaiseh M. Influence of mydriasis on optical coherence tomography angiography imaging in patients with age-related macular degeneration. PLoS One 2019; 14:e0223452. [PMID: 31584983 PMCID: PMC6777775 DOI: 10.1371/journal.pone.0223452] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 09/20/2019] [Indexed: 01/08/2023] Open
Abstract
Purpose To evaluate the effect of topical mydriatic eye drops on optical coherence tomography angiography (OCTA) parameters in patients with age-related macular degeneration (AMD). Methods 27 eyes of 27 patients suffering from AMD were included in this cross-sectional study. Patients with ≥-4.5 diopters spherical equivalent, corneal opacities or dense cataract preventing high-quality imaging were excluded. Whole-en-face scans of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) in the central 3x3mm foveal region as well as whole-en-face and peripapillary scans of the radial peripapillary capillaries (RPC) were generated using OCTA (AngioVue®, Optovue). Imaging was first conducted with patients’ eyes in miosis, then in mydriasis after instillation of a dilating eye drop (0.5% tropicamide, 2.5% phenylephrine-HCl). Main outcome measures were flow density (FD), foveal avascular zone (FAZ), signal strength index (SSI) and motion artifact score (MAS). Results Our results reveal that in AMD patients there is no significant difference between FD measurements taken in miosis and those taken in mydriasis around the SCP (p = 0.198), DCP (p = 0.458), RPC whole-en-face (p = 0.275) and RPC peripapillary (p = 0.503). Measurements taken in these two states appear to be equivalent for assessment of FD (90%CI within ± 0.05). No significant difference was found either in the area of the FAZ (p = 0.338) or in the SSI (p = 0.371) before and after the instillation of tropicamide/phenylephrine. MAS was significantly lower after the application of mydriatic eye drops (p = 0.003). Conclusions Our findings reveal that neither measurements of FD nor measurements of the FAZ area changed significantly in AMD patients after the application of tropicamide/phenylephrine. Since MAS improved significantly in dilation, mydriatic examination is recommended. Nevertheless, a comparison of OCTA metrics from images taken with different pupil states (miosis versus mydriasis) is valid for clinical trials.
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Affiliation(s)
- Viktoria C. Brücher
- Department of Ophthalmology, University of Muenster Medical Centre, Muenster, North Rhine-Westphalia, Germany
- * E-mail:
| | - Jens J. Storp
- Department of Ophthalmology, University of Muenster Medical Centre, Muenster, North Rhine-Westphalia, Germany
| | - Laura Kerschke
- Department of Biometry and Clinical Research, University of Muenster Medical Centre, Muenster, North Rhine-Westphalia, Germany
| | - Pieter Nelis
- Department of Ophthalmology, University of Muenster Medical Centre, Muenster, North Rhine-Westphalia, Germany
| | - Nicole Eter
- Department of Ophthalmology, University of Muenster Medical Centre, Muenster, North Rhine-Westphalia, Germany
| | - Maged Alnawaiseh
- Department of Ophthalmology, University of Muenster Medical Centre, Muenster, North Rhine-Westphalia, Germany
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144
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Hsieh YT, Alam MN, Le D, Hsiao CC, Yang CH, Chao DL, Yao X. OCT Angiography Biomarkers for Predicting Visual Outcomes after Ranibizumab Treatment for Diabetic Macular Edema. Ophthalmol Retina 2019; 3:826-834. [PMID: 31227330 PMCID: PMC6921516 DOI: 10.1016/j.oret.2019.04.027] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 04/05/2019] [Accepted: 04/26/2019] [Indexed: 04/12/2023]
Abstract
PURPOSE To correlate quantitative OCT angiography (OCTA) biomarkers with clinical features and to predict the extent of visual improvement after ranibizumab treatment for diabetic macular edema (DME) with OCTA biomarkers. DESIGN Retrospective, longitudinal study in Taiwan. PARTICIPANTS Fifty eyes of 50 patients with DME and 22 eyes of 22 healthy persons, with the exception of cataract and refractive error, from 1 hospital. METHODS Each eye underwent OCT angiography (RTVue XR Avanti System with AngioVue software version 2017.1; Optovue, Fremont, CA), and 3×3-mm2 en face OCTA images of the superficial layer and the deep layer were obtained at baseline and after 3 monthly injections of ranibizumab in the study group. OCT angiography images also were acquired from the control group. MAIN OUTCOME MEASURES Five OCTA biomarkers, including foveal avascular zone (FAZ) area (FAZ-A), FAZ contour irregularity (FAZ-CI), average vessel caliber (AVC), vessel tortuosity (VT), and vessel density (VD), were analyzed comprehensively. Best-corrected visual acuity (BCVA) and central retinal thickness (CRT) also were obtained. Student t tests were used to compare the OCTA biomarkers between the study group and the control group. Linear regression models were used to evaluate the correlations between the baseline OCTA biomarkers and the changes of BCVA and CRT after treatment. RESULTS Eyes with DME had larger AVC, VT, FAZ-A, and FAZ-CI and lower VD than those in the control group (P < 0.001 for all). After the loading ranibizumab treatment, these OCTA biomarkers improved but did not return to normal levels. Among all biomarkers, higher inner parafoveal VD in the superficial layer at baseline correlated most significantly with visual gain after treatment in the multiple regression model with adjustment for CRT and ellipsoid zone disruption (P < 0.001). To predict visual improvement, outer parafoveal VD in the superficial layer at the baseline showed the largest area under the receiver operating characteristic curve (0.787; P = 0.004). No baseline OCTA biomarkers showed any significant correlation specifically with anatomic improvement. CONCLUSIONS For eyes with DME, parafoveal VD in the superficial layer at baseline was an independent predictor for visual improvement after the loading ranibizumab treatment.
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Affiliation(s)
- Yi-Ting Hsieh
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan.
| | - Minhaj Nur Alam
- Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois
| | - David Le
- Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois
| | - Chia-Chieh Hsiao
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chang-Hao Yang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan; School of Medicine, National Taiwan University, Taipei, Taiwan
| | - Daniel L Chao
- Shiley Eye Institute, Department of Ophthalmology, University of California San Diego, San Diego, California
| | - Xincheng Yao
- Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois
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Dupas B, Minvielle W, Bonnin S, Couturier A, Erginay A, Massin P, Gaudric A, Tadayoni R. Association Between Vessel Density and Visual Acuity in Patients With Diabetic Retinopathy and Poorly Controlled Type 1 Diabetes. JAMA Ophthalmol 2019; 136:721-728. [PMID: 29800967 DOI: 10.1001/jamaophthalmol.2018.1319] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Capillary dropout is a hallmark of diabetic retinopathy, but its role in visual loss remains unclear. Objective To examine how macular vessel density is correlated with visual acuity (VA) in patients younger than 40 years who have type 1 diabetes without macular edema but who have diabetic retinopathy requiring panretinal photocoagulation. Design, Settings, and Participants Retrospective cohort study of VA and optical coherence tomography angiography data collected from consecutive patients during a single visit to Lariboisière Hospital, a tertiary referral center in Paris, France. The cohort included 22 eyes of 22 patients with type 1 diabetes without macular edema but with bilateral rapidly progressive diabetic retinopathy that was treated with panretinal photocoagulation between August 15, 2015, and December 30, 2016. Eyes were classified into 2 groups by VA: normal (logMAR, 0; Snellen equivalent, 20/20) and decreased (logMAR, >0; Snellen equivalent, <20/20). The control group included 12 eyes from age-matched healthy participants with normal vision. Main Outcomes and Measures Visual acuity and mean vessel density in 4 retinal vascular plexuses: the superficial vascular plexus and the deep capillary complex, which comprises the intermediate capillary plexus and the deep capillary plexus. Results Of the 22 participants, 11 (50%) were men, mean (SD) age was 30 (6) years, and mean (SD) hemoglobin A1c level was 8.9% (1.6%). Of the 22 eyes with diabetic retinopathy, 13 (59%) had normal VA and 9 (41%) had decreased VA (mean [SD]: logMAR, 0.12 [0.04]; Snellen equivalent, 20/25). Mean [SE] vessel density was lower for eyes with diabetic retinopathy and normal VA compared with the control group in the superficial vascular plexus (44.1% [0.9%] vs 49.1% [0.9%]; difference, -5.0% [1.3%]; 95% CI, -7.5% to -2.4%; P < .001), in the deep capillary complex (44.3% [1.2%] vs 50.6% [1.3%]; difference, -6.3% [1.8%]; 95% CI, -9.9% to -2.7%; P = .001), in the intermediate capillary plexus (43.8% [1.2%] vs 49.3% [1.2%]; difference, -5.5% [1.7%]; 95% CI, -9.0% to -2.0%; P = .003), and in the deep capillary plexus (24.5% [1.0%] vs 30.5% [1.0%]; difference, -6.1% [1.4%]; 95% CI, -8.9% to -3.2%; P < .001). Mean vessel density was lower in eyes with diabetic retinopathy and decreased VA compared with eyes with diabetic retinopathy and normal VA; the mean (SE) loss was more pronounced in the deep capillary complex (34.6% [1.5%] vs 44.3% [1.2%]; difference, -9.6% [1.9%]; 95% CI, -13.6% to -5.7%; P < .001), especially in the deep capillary plexus (15.2% [1.2%] vs 24.5% [1.0%]; difference, -9.3% [1.5%]; 95% CI, -12.4% to -6.1%; P < .001), than in the superficial vascular plexus (39.6% [1.1%] vs 44.1% [0.9%]; difference, -4.5% [1.4%]; 95% CI, -7.3% to -1.7%; P = .002). Conclusions and Relevance These data suggest that in patients with type 1 diabetes without macular edema but with severe nonproliferative or proliferative diabetic retinopathy, decreased VA may be associated with the degree of capillary loss in the deep capillary complex.
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Affiliation(s)
- Bénédicte Dupas
- Department of Ophthalmology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, University Sorbonne Paris Cité, Paris, France
| | - Wilfried Minvielle
- Department of Ophthalmology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, University Sorbonne Paris Cité, Paris, France
| | - Sophie Bonnin
- Department of Ophthalmology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, University Sorbonne Paris Cité, Paris, France
| | - Aude Couturier
- Department of Ophthalmology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, University Sorbonne Paris Cité, Paris, France
| | - Ali Erginay
- Department of Ophthalmology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, University Sorbonne Paris Cité, Paris, France
| | - Pascale Massin
- Department of Ophthalmology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, University Sorbonne Paris Cité, Paris, France
| | - Alain Gaudric
- Department of Ophthalmology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, University Sorbonne Paris Cité, Paris, France
| | - Ramin Tadayoni
- Department of Ophthalmology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, University Sorbonne Paris Cité, Paris, France
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146
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Binotti WW, Romano AC. Projection-Resolved Optical Coherence Tomography Angiography Parameters to Determine Severity in Diabetic Retinopathy. Invest Ophthalmol Vis Sci 2019; 60:1321-1327. [PMID: 30933259 DOI: 10.1167/iovs.18-24154] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this study was to assess projection-resolved optical coherence tomography angiography (PR-OCTA) vessel density (VD) and foveal avascular zone (FAZ) in determining severity within diabetic retinopathy (DR) and their accuracy in identifying high-risk DR patients. Methods This was a retrospective study with 72 eyes of 52 DR patients, assessing the VD and FAZ area of the superficial capillary plexus (SCP) and deep vascular plexus (DVP), for both 3 × 3-mm and 6 × 6-mm scans between the DR groups (mild to moderate, severe and proliferative DR [PDR]). For accuracy, the severe and PDR groups were merged, representing the high-risk DR group for receiver operator characteristic analysis. VD of OCTA images with and without PR were compared. Results In mild to moderate, severe, and PDR groups, there were 31, 21, and 20 eyes, respectively. PR-OCTA improved VD analysis only in the DVP and particularly in advanced DR stages (P = 0.042). In the 3 × 3-mm PR scans, all superficial and deep parameters were significantly different between severe and PDR groups (P ≤ 0.020), but only the mean VD of SCP and DVP was also significant between the mild to moderate and severe groups (P ≤ 0.007). In the 6 × 6-mm scans, the superficial VD, deep VD, and superficial FAZ were significantly different between the severe and PDR groups (P ≤ 0.029). The superficial VD and deep VD of the 3 × 3-mm scans were good parameters for detecting high-risk patients (area under the curve = 0.829 and 0.895, respectively). Conclusions PR-OCTA improved VD analysis of DVP. The 3 × 3-mm SCP and DVP VD were the most accurate in detecting high-risk DR.
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Sacconi R, Casaluci M, Borrelli E, Mulinacci G, Lamanna F, Gelormini F, Carnevali A, Querques L, Zerbini G, Bandello F, Querques G. Multimodal Imaging Assessment of Vascular and Neurodegenerative Retinal Alterations in Type 1 Diabetic Patients without Fundoscopic Signs of Diabetic Retinopathy. J Clin Med 2019; 8:jcm8091409. [PMID: 31500344 PMCID: PMC6780853 DOI: 10.3390/jcm8091409] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 08/28/2019] [Accepted: 09/03/2019] [Indexed: 11/26/2022] Open
Abstract
The aim of this cross-sectional case-control study is to investigate the possible presence of vascular/neurodegenerative alterations in the retina of type 1 diabetes mellitus (T1DM) patients without diabetic retinopathy (DR). Thirty-four eyes of 34 consecutive T1DM without DR (mean age 21 ± 2 years) were included. Another cohort of 27 eyes (27 healthy control subjects matched with age and sex) was also recruited. All patients underwent multimodal imaging evaluation using structural optical coherence tomography (OCT), OCT-angiography (OCT-A), dynamic vessel analyzer (DVA) and microperimetry. No significant differences were disclosed comparing diabetics and controls for visual acuity, central macular thickness, and subfoveal choroidal thickness. On retinal nerve fiber layer and ganglion cell complex thickness, no significant differences were disclosed comparing each 3-mm-diameter macular and peripapillary subfield between two groups. Using OCT-A, deep capillary plexus perfusion density (PD) of diabetics was significantly lower compared to control group, whereas PD of other retinal/choriocapillaris plexuses and foveal avascular zone area did not show any significant difference. Using DVA, diabetic eyes revealed a significantly decreased vessel response to flicker light in comparison to controls. No differences were disclosed using microperimetry analysis. Taken together, these results suggest that vascular alterations could be the first detectable retinal change in the development of DR.
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Affiliation(s)
- Riccardo Sacconi
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy.
| | - Marco Casaluci
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy.
| | - Enrico Borrelli
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy.
| | - Giacomo Mulinacci
- Complications of Diabetes Unit, Division of Metabolic and Cardiovascular Sciences, San Raffaele Scientific Institute, 20132 Milan, Italy.
| | - Francesca Lamanna
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy.
| | - Francesco Gelormini
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy.
| | - Adriano Carnevali
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy.
| | - Lea Querques
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy.
| | - Gianpaolo Zerbini
- Complications of Diabetes Unit, Division of Metabolic and Cardiovascular Sciences, San Raffaele Scientific Institute, 20132 Milan, Italy.
| | - Francesco Bandello
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy.
| | - Giuseppe Querques
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy.
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Shiraki A, Sakimoto S, Tsuboi K, Wakabayashi T, Hara C, Fukushima Y, Sayanagi K, Nishida K, Sakaguchi H, Nishida K. Evaluation of retinal nonperfusion in branch retinal vein occlusion using wide-field optical coherence tomography angiography. Acta Ophthalmol 2019; 97:e913-e918. [PMID: 30900381 DOI: 10.1111/aos.14087] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 02/16/2019] [Indexed: 01/13/2023]
Abstract
PURPOSE To characterize wide-field optical coherence tomography angiography (OCTA) features of retinal nonperfusion in eyes with branch retinal vein occlusion (BRVO). METHODS Automated scanning of five 12 × 12-mm areas of swept-source OCTA and wide-field fluorescein angiography (FA) images was performed in a consecutive case series of 27 eyes in 27 patients with BRVO in this institutional cross-sectional study. The correlation between the areas of retinal nonperfusion detected by both examinations was assessed. Panoramic images obtained in five 12 × 12-mm OCTA scans in eyes with retinal nonperfusion were binarized or skeletonized, and the associations between vascular parameters such as vascular density (VD) and vascular length (VL) with the wide-field FA characteristics were evaluated. RESULTS The mean area of retinal nonperfusion in the OCTA images was 81.0 ± 66.8 mm2 (range, 0.0-188.8). The mean areas of retinal nonperfusion in FA and the total FA images were, respectively, 84.7 ± 72.5 mm2 (range, 0.0-221.9) and 184.1 ± 167.7 mm2 (range, 0.0-515.0). The mean VD was 27.6 ± 3.5% (range, 19.6-33.7), and the mean VL was 12.4 ± 8.5% (range, 5.4-31.3). Separate regression analyses of the areas of retinal nonperfusion in FA (p = 0.0004, R2 = 0.4627) and the total FA (p = 0.0008, R2 = 0.4214) images showed a significant association with the VL. CONCLUSIONS OCTA images based on wide-field technologies can quantitatively evaluate retinal nonperfusion in eyes with BRVO.
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Affiliation(s)
- Akihiko Shiraki
- Department of Ophthalmology Osaka University Graduate School of Medicine Yamadaoka Japan
| | - Susumu Sakimoto
- Department of Ophthalmology Osaka University Graduate School of Medicine Yamadaoka Japan
| | - Kotaro Tsuboi
- Department of Ophthalmology Aichi Medical University Nagakute Japan
| | - Taku Wakabayashi
- Department of Ophthalmology Osaka University Graduate School of Medicine Yamadaoka Japan
| | - Chikako Hara
- Department of Ophthalmology Osaka University Graduate School of Medicine Yamadaoka Japan
| | - Yoko Fukushima
- Department of Ophthalmology Osaka University Graduate School of Medicine Yamadaoka Japan
| | - Kaori Sayanagi
- Department of Ophthalmology Osaka University Graduate School of Medicine Yamadaoka Japan
| | - Kentaro Nishida
- Department of Ophthalmology Osaka University Graduate School of Medicine Yamadaoka Japan
| | - Hirokazu Sakaguchi
- Department of Ophthalmology Osaka University Graduate School of Medicine Yamadaoka Japan
| | - Kohji Nishida
- Department of Ophthalmology Osaka University Graduate School of Medicine Yamadaoka Japan
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Bowers DT, Song W, Wang LH, Ma M. Engineering the vasculature for islet transplantation. Acta Biomater 2019; 95:131-151. [PMID: 31128322 PMCID: PMC6824722 DOI: 10.1016/j.actbio.2019.05.051] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 04/13/2019] [Accepted: 05/20/2019] [Indexed: 12/17/2022]
Abstract
The microvasculature in the pancreatic islet is highly specialized for glucose sensing and insulin secretion. Although pancreatic islet transplantation is a potentially life-changing treatment for patients with insulin-dependent diabetes, a lack of blood perfusion reduces viability and function of newly transplanted tissues. Functional vasculature around an implant is not only necessary for the supply of oxygen and nutrients but also required for rapid insulin release kinetics and removal of metabolic waste. Inadequate vascularization is particularly a challenge in islet encapsulation. Selectively permeable membranes increase the barrier to diffusion and often elicit a foreign body reaction including a fibrotic capsule that is not well vascularized. Therefore, approaches that aid in the rapid formation of a mature and robust vasculature in close proximity to the transplanted cells are crucial for successful islet transplantation or other cellular therapies. In this paper, we review various strategies to engineer vasculature for islet transplantation. We consider properties of materials (both synthetic and naturally derived), prevascularization, local release of proangiogenic factors, and co-transplantation of vascular cells that have all been harnessed to increase vasculature. We then discuss the various other challenges in engineering mature, long-term functional and clinically viable vasculature as well as some emerging technologies developed to address them. The benefits of physiological glucose control for patients and the healthcare system demand vigorous pursuit of solutions to cell transplant challenges. STATEMENT OF SIGNIFICANCE: Insulin-dependent diabetes affects more than 1.25 million people in the United States alone. Pancreatic islets secrete insulin and other endocrine hormones that control glucose to normal levels. During preparation for transplantation, the specialized islet blood vessel supply is lost. Furthermore, in the case of cell encapsulation, cells are protected within a device, further limiting delivery of nutrients and absorption of hormones. To overcome these issues, this review considers methods to rapidly vascularize sites and implants through material properties, pre-vascularization, delivery of growth factors, or co-transplantation of vessel supporting cells. Other challenges and emerging technologies are also discussed. Proper vascular growth is a significant component of successful islet transplantation, a treatment that can provide life-changing benefits to patients.
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Affiliation(s)
- Daniel T Bowers
- Department of Biological and Environmental Engineering, Cornell University, Ithaca, NY 14853, USA
| | - Wei Song
- Department of Biological and Environmental Engineering, Cornell University, Ithaca, NY 14853, USA
| | - Long-Hai Wang
- Department of Biological and Environmental Engineering, Cornell University, Ithaca, NY 14853, USA
| | - Minglin Ma
- Department of Biological and Environmental Engineering, Cornell University, Ithaca, NY 14853, USA.
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Lauermann P, van Oterendorp C, Storch MW, Khattab MH, Feltgen N, Hoerauf H, Bemme S. Distance-Thresholded Intercapillary Area Analysis Versus Vessel-Based Approaches to Quantify Retinal Ischemia in OCTA. Transl Vis Sci Technol 2019; 8:28. [PMID: 31440425 PMCID: PMC6701872 DOI: 10.1167/tvst.8.4.28] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 06/04/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose To develop and compare different analytic approaches for quantifying ischemia in OCT-angiography (OCTA), including vessel-based approaches and intercapillary area analysis. Methods En face OCTA (6 × 6) images of the superficial plexus of 20 healthy eyes and 20 eyes with different ischemic retinal diseases were analyzed retrospectively. Included retinal diseases were diabetic retinopathy (n = 9), central (n = 5) and branch retinal vein occlusion (n = 4), hypertensive retinopathy (n = 1), and occlusive retinal vasculitis in sarcoidosis (n = 1). Vessel-based approaches consisted of the mean gray scale, perfusion density, and vessel density. Intercapillary areas (ICAs) were analyzed measuring the distance of each intercapillary pixel from the surrounding vessels. In particular, we applied a vector method to measure the shortest, the mean, and the longest distance in eight predefined directions. Size of ICAs was determined applying different global or local distance thresholds. Results All approaches revealed significant differences between ischemic and healthy retinae (P < 0.001, with Bonferroni-Holm correction P = 0.001–0.025; Wilcoxon-Mann-Whitney test). Discrimination between the healthy and ischemic retinae based on ROC curves was best in the ICA analysis using a locally set threshold of the shortest distance. Conclusions In the present study, ICA analysis was superior to vessel-based approaches in the quantification of retinal ischemia when defining a local or global distance threshold. Translational Relevance In order to establish OCTA imaging in everyday clinical and scientific practice, standardized, device-independent image analysis methods are necessary.
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Affiliation(s)
- Peer Lauermann
- Department of Ophthalmology, University Medical Center Göttingen, Göttingen, Germany
| | | | - Marcus W Storch
- Department of Ophthalmology, University Medical Center Göttingen, Göttingen, Germany
| | - Mohammed H Khattab
- Department of Ophthalmology, University Medical Center Göttingen, Göttingen, Germany
| | - Nicolas Feltgen
- Department of Ophthalmology, University Medical Center Göttingen, Göttingen, Germany
| | - Hans Hoerauf
- Department of Ophthalmology, University Medical Center Göttingen, Göttingen, Germany
| | - Sebastian Bemme
- Department of Ophthalmology, University Medical Center Göttingen, Göttingen, Germany
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